Provider Demographics
NPI:1902820020
Name:WALKER, KENT R (DO)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:R
Last Name:WALKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 LAKE TAPPS PKWY SE
Mailing Address - Street 2:STE F104 #133
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092
Mailing Address - Country:US
Mailing Address - Phone:541-969-3344
Mailing Address - Fax:
Practice Address - Street 1:16202 64TH ST E STE 104
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3028
Practice Address - Country:US
Practice Address - Phone:541-969-3344
Practice Address - Fax:253-987-7049
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20295207QS0010X
WAOP00001577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0432757OtherLABOR AND INDUSTRIES
WAP02570879OtherMEDICARE RR
WAG9017261OtherMEDICARE
OR150117Medicaid