MEDICARE: LINDA A WALKOWICZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	10299	TN
2	367500000X	Certified Registered Nurse Anesthetist	28074127A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3125033	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1952380636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A WALKOWICZ CRNA

Provider Business Mailing Address
First Line	:	10415 WALLACE ALLEY ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-3936
Country	:	US
Telephone Number	:	423-390-0451
Fax Number	:

Provider Business Practice Location Address
First Line	:	10415 WALLACE ALLEY ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-3936
Country	:	US
Telephone Number	:	423-390-0451
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	01/31/2025

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Directions to “ LINDA A WALKOWICZ CRNA” Practice Location

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