Healthcare Provider Details

I. General information

NPI: 1568576478
Provider Name (Legal Business Name): WALTER LEVON EDWARDS R.R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

5 BJORN BORG CT
LITTLE ROCK AR
72210-5721
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-5772
  • Fax:
Mailing address:
  • Phone: 501-455-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number1258
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: