Provider Demographics
NPI:1730731498
Name:WALKLEY, ERIN GAIL (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:GAIL
Last Name:WALKLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:GAIL
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 S BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3154
Mailing Address - Country:US
Mailing Address - Phone:719-686-7776
Mailing Address - Fax:
Practice Address - Street 1:403 S BALDWIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3154
Practice Address - Country:US
Practice Address - Phone:719-686-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1004X
COPA.0007574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401157901Medicaid