Active NPI
Mary Jean Walker, APRN
- Obstetrics & Gynecology Nurse Practitioner
- Glastonbury, CT
National Provider Identifier
1669571428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Nurse Practitioner
- License
- 000442
- Practice address
- 300 Western Boulevard
Glastonbury, CT 06033 - Phone
- (860) 547-0306
- Fax
- (860) 525-9782
- NPI assigned
- Sep 21, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Nurse Practitioner | 363LX0001X | 000442 | CT | Primary |
Addresses
Primary practice location
300 Western Boulevard
Glastonbury, CT 06033
Mailing address
300 Western Blvd
Glastonbury, CT 06033-4305
Phone (860) 525-9767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004208139 | Medicaid | CT |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000442 | CT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1669571428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 WESTERN BLVD",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060334305",
"telephone_number": "860-525-9767",
"fax_number": "860-525-9782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 WESTERN BOULEVARD",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "06033",
"telephone_number": "860-547-0306",
"fax_number": "860-525-9782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "MARY JEAN",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-21",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LX0001X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Obstetrics & Gynecology",
"state": "CT",
"license": "000442",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004208139",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.