Healthcare Provider Details

I. General information

NPI: 1952498578
Provider Name (Legal Business Name): JAMES BOLLING WALKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

272 HOSPITAL RD SUITE 3
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7540
  • Fax: 740-779-7867
Mailing address:
  • Phone: 740-779-8234
  • Fax: 740-779-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4605A
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA08120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: