Healthcare Provider Details

I. General information

NPI: 1326771882
Provider Name (Legal Business Name): EMILY ROSE WALKER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

920 TWIN BRIDGES RD APT 49
ALEXANDRIA LA
71303-2071
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-2175
  • Fax:
Mailing address:
  • Phone: 318-451-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number337856
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: