MEDICARE: STACY WALKER PHD, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	36001094A	IN

General Provider Information

NPI Number	:	1073587622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY WALKER PHD, ATC

Provider Business Mailing Address
First Line	:	HEALTH PROFESSIONS BUILDING 439
Second Line	:	BALL STATE UNIVERSITY
City	:	MUNCIE
State	:	IN
Zip	:	47306-0001
Country	:	US
Telephone Number	:	765-285-5175
Fax Number	:

Provider Business Practice Location Address
First Line	:	HEALTH PROFESSIONS BUILDING 439
Second Line	:	BALL STATE UNIVERSITY
City	:	MUNCIE
State	:	IN
Zip	:	47306
Country	:	US
Telephone Number	:	765-285-5175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/08/2019

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