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General NPI Number Information
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NPI Number | 1003419318
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Entity Type | Individual
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Provider Name | KARLIE D WALKUP MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 13055 W MCDOWELL RD STE G107
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City | AVONDALE
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State | AZ
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Zip | 85392-6450
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Country | US
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Telephone | 916-599-1114
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Fax |
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Provider Business Mailing Address
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Address Line | 8203 W ORAIBI DR APT 1110
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City | PEORIA
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State | AZ
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Zip | 85382-4690
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Country | US
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Telephone | 916-599-1114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATR-009444
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License Number State | AZ
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