MEDICARE: NAKKIA WALTON BT

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1194502971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKKIA WALTON BT

Provider Business Mailing Address
First Line	:	PO BOX 42214
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-0004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-0202
Country	:	US
Telephone Number	:	855-837-6727
Fax Number	:

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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