Provider Demographics
NPI:1003419318
Name:WALKUP, KARLIE D (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:D
Last Name:WALKUP
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 W ORAIBI DR APT 1110
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4690
Mailing Address - Country:US
Mailing Address - Phone:916-599-1114
Mailing Address - Fax:
Practice Address - Street 1:13055 W MCDOWELL RD STE G107
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6450
Practice Address - Country:US
Practice Address - Phone:916-599-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0094442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer