Healthcare Provider Details

I. General information

NPI: 1003362880
Provider Name (Legal Business Name): TRAVIS WALKER AEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HOSPITAL ROAD
SCHURZ NV
89427
US

IV. Provider business mailing address

15 WILD PEACH LN
WELLINGTON NV
89444-9504
US

V. Phone/Fax

Practice location:
  • Phone: 775-773-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number71702
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: