Active NPI
Reva Marie Mace Walker, RN
- Ambulatory Women's Health Care Registered Nurse
- Vicksburg, MS
National Provider Identifier
1427875889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Women's Health Care Registered Nurse
- License
- 901802
- Practice address
- 2007 Highland PL
Vicksburg, MS 39180-4554 - Phone
- (601) 218-2796
- NPI assigned
- Sep 25, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lactation Consultant (Registered Nurse) | 163WL0100X | 902801 | MS | |
| Ambulatory Women's Health Care Registered Nurse | 163WW0101X | 901802 | MS | Primary |
Addresses
Primary practice location
2007 Highland PL
Vicksburg, MS 39180-4554
Mailing address
2007 Highland PL
Vicksburg, MS 39180-4554
Phone (601) 218-2796
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902801 | MS | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1427875889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2007 HIGHLAND PL",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391804554",
"telephone_number": "601-218-2796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2007 HIGHLAND PL",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391804554",
"telephone_number": "601-218-2796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "REVA",
"middle_name": "MARIE MACE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-25",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "163WL0100X",
"taxonomy_group": "",
"desc": "Registered Nurse, Lactation Consultant",
"state": "MS",
"license": "902801",
"primary": false
},
{
"code": "163WW0101X",
"taxonomy_group": "",
"desc": "Registered Nurse, Women's Health Care, Ambulatory",
"state": "MS",
"license": "901802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.