Provider Demographics
NPI:1497014468
Name:WALKER, E KEITH (LVN)
Entity Type:Individual
Prefix:MR
First Name:E
Middle Name:KEITH
Last Name:WALKER
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34585
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-4585
Mailing Address - Country:US
Mailing Address - Phone:858-490-1134
Mailing Address - Fax:
Practice Address - Street 1:4965 REBEL RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-1218
Practice Address - Country:US
Practice Address - Phone:858-490-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 261548164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse