MEDICARE: BRANDON THOMAS 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
1	390200000X	Student in an Organized Health Care Education/Training Program		VA
2	2255A2300X	Athletic Trainer		VA

General Provider Information

NPI Number	:	1275462889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON THOMAS WALKER

Provider Business Mailing Address
First Line	:	111 NORTHWYND CIR APT 24
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2984
Country	:	US
Telephone Number	:	804-658-6712
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 NORTHWYND CIR APT 24
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2984
Country	:	US
Telephone Number	:	804-658-6712
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/19/2026

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