Healthcare Provider Details

I. General information

NPI: 1619785615
Provider Name (Legal Business Name): JOHNA C WALKER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 MIDDLE TENNESSEE BLVD
MURFREESBORO TN
37132-0001
US

IV. Provider business mailing address

901 W MAIN ST
MURFREESBORO TN
37129-3436
US

V. Phone/Fax

Practice location:
  • Phone: 859-436-8259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3257
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: