Healthcare Provider Details

I. General information

NPI: 1902818057
Provider Name (Legal Business Name): THOMAS FRANKLIN WALKER AT EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TOM F WALKER AT EMT

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HOQUIAM AVE NE
RENTON WA
98059-4314
US

IV. Provider business mailing address

1101 HOQUIAM AVE NE
RENTON WA
98059-4314
US

V. Phone/Fax

Practice location:
  • Phone: 425-204-4339
  • Fax: 425-204-4279
Mailing address:
  • Phone: 425-204-4339
  • Fax: 425-204-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA160047329
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0101189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: