Tracy Walker

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

66 Pavilion Ave
Providence, RI 02905-1522

Phone

(401) 461-9110

Fax

(401) 461-9194

NPI assigned

Oct 6, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1174285332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 PAVILION AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029051522",
            "telephone_number": "401-461-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PAVILION AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029051522",
            "telephone_number": "401-461-9110",
            "fax_number": "401-461-9194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "TRACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174521488",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Tracy.Walker@ctcprograms.com",
            "affiliation": "N",
            "endpointDescription": "Work Email",
            "address_1": "66 Pavilion Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029051522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kayla Rose Walker
• Maxine Walker, RPH
• Nathan Charles Walker, LMT, CMLDT, OMT
• Suhaiylah Walker, RN
• Tammy Walker, PHARMD
• William Scott Walker, MD
• Barry W Wall, M.D.
• Bryce Wall, MD
• James Barta Wall, MD
• Gemma Wallace, PHD

• Addiction (Substance Use Disorder) Counselor in Providence, RI
• Providers in Providence, RI by specialty
• Addiction (Substance Use Disorder) Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.