Provider Demographics
NPI:1730683319
Name:WALKER, TIFFANY (NP)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5014
Mailing Address - Country:US
Mailing Address - Phone:702-357-8811
Mailing Address - Fax:702-357-8811
Practice Address - Street 1:6870 S RAINBOW BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2107
Practice Address - Country:US
Practice Address - Phone:702-396-6000
Practice Address - Fax:702-396-6001
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730683319Medicaid