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NPI Code Detail

MEDICARE: TOMMY LEE WALKER

MEDICARE: TOMMY LEE WALKER
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
1103K00000XBehavior Analyst2103895933NV

General Provider Information

NPI Number : 1235564410
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMY LEE WALKER
Provider Business Mailing Address
First Line : 8350 W DESERT INN RD APT 2023
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-9120
Country : US
Telephone Number : 702-688-3551
Fax Number :
Provider Business Practice Location Address
First Line : 8350 W DESERT INN RD APT 2023
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-9120
Country : US
Telephone Number : 702-688-3551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2013
Last Update Date : 09/06/2013

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