MEDICARE: MR. JAMES ELI WALTON III CRNA

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	367500000X	Certified Registered Nurse Anesthetist	63350	MO
2	367500000X	Certified Registered Nurse Anesthetist	3700A	KY
3	367500000X	Certified Registered Nurse Anesthetist	4704232737	MI
4	367500000X	Certified Registered Nurse Anesthetist	1-096408	AL
5	367500000X	Certified Registered Nurse Anesthetist	181213	NC
6	367500000X	Certified Registered Nurse Anesthetist	APN1582	SC
7	367500000X	Certified Registered Nurse Anesthetist	685016	TX
8	367500000X	Certified Registered Nurse Anesthetist	R0076777	OK

General Provider Information

NPI Number	:	1144223389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ELI WALTON III CRNA

Provider Business Mailing Address
First Line	:	9508 NE 98TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-7717
Country	:	US
Telephone Number	:	816-429-6895
Fax Number	:

Provider Business Practice Location Address
First Line	:	9508 NE 98TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-7717
Country	:	US
Telephone Number	:	417-848-1484
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/03/2008

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