MEDICARE: TRAVIS WALKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1316583834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS WALKER

Provider Business Mailing Address
First Line	:	12401 N MACARTHUR BLVD APT 2706
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-3064
Country	:	US
Telephone Number	:	405-924-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 LINDA LN
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5012
Country	:	US
Telephone Number	:	405-724-8937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “ TRAVIS WALKER ” Practice Location

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