MEDICARE: MR. AHAVA CUSHAN WALKER EMT

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	172A00000X	Driver	T62988901	VA

General Provider Information

NPI Number	:	1396689972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AHAVA CUSHAN WALKER EMT

Provider Business Mailing Address
First Line	:	5602 CRENSHAW RD APT 1624
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2521
Country	:	US
Telephone Number	:	804-822-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	5602 CRENSHAW RD APT 1624
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2521
Country	:	US
Telephone Number	:	804-822-6829
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	06/26/2026

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