Healthcare Provider Details

I. General information

NPI: 1306143029
Provider Name (Legal Business Name): JEFF P WALKER CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9499 W CHARLESTON BLVD SUITE 250
LAS VEGAS NV
89117-7150
US

IV. Provider business mailing address

9499 W CHARLESTON BLVD SUITE 250
LAS VEGAS NV
89117-7150
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-9600
  • Fax: 702-933-9601
Mailing address:
  • Phone: 702-933-9600
  • Fax: 702-933-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number116885
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: