Healthcare Provider Details

I. General information

NPI: 1932519980
Provider Name (Legal Business Name): MARTY WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 OHIO ST
KENNER LA
70065-4435
US

IV. Provider business mailing address

3024 OHIO ST
KENNER LA
70065-4435
US

V. Phone/Fax

Practice location:
  • Phone: 504-428-6133
  • Fax:
Mailing address:
  • Phone: 504-428-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number004530995
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number004530995
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: