Healthcare Provider Details

I. General information

NPI: 1902727753
Provider Name (Legal Business Name): WALTER CROWLEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3169 NC 8 HWY S
WALNUT COVE NC
27052-5693
US

IV. Provider business mailing address

9128 NOLLEY CT UNIT E
CHARLOTTE NC
28270-3409
US

V. Phone/Fax

Practice location:
  • Phone: 704-993-8121
  • Fax:
Mailing address:
  • Phone: 704-993-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP544985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: