Provider Demographics
NPI:1023066172
Name:WALKER, NITA (MD)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:9275 MONTGOMERY RD
Practice Address - Street 2:STE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7779
Practice Address - Country:US
Practice Address - Phone:513-936-4510
Practice Address - Fax:513-936-4511
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200036340Medicaid
OH0861803Medicaid
OH110107926OtherRAIL ROAD MEDICARE
KY64867369Medicaid
E92081Medicare UPIN
OHWA0804039Medicare PIN