Healthcare Provider Details

I. General information

NPI: 1902820020
Provider Name (Legal Business Name): KENT R WALKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16202 64TH ST E STE 104
SUMNER WA
98390-3028
US

IV. Provider business mailing address

1402 LAKE TAPPS PKWY SE STE F104 #133
AUBURN WA
98092
US

V. Phone/Fax

Practice location:
  • Phone: 541-969-3344
  • Fax: 253-987-7049
Mailing address:
  • Phone: 541-969-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20295
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: