MEDICARE: JOHNAL WALKER JR. RN

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	163WH0500X	Hemodialysis Registered Nurse	783026	TX

General Provider Information

NPI Number	:	1184210353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNAL WALKER JR. RN

Provider Business Mailing Address
First Line	:	1111 MISTY LEA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1233
Country	:	US
Telephone Number	:	346-290-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	7115 NORTH LOOP E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-5948
Country	:	US
Telephone Number	:	866-544-6741
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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