Provider Demographics
NPI:1841092269
Name:WALKER, KENTON
Entity type:Individual
Prefix:
First Name:KENTON
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-2824
Mailing Address - Country:US
Mailing Address - Phone:252-241-4886
Mailing Address - Fax:
Practice Address - Street 1:203 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2824
Practice Address - Country:US
Practice Address - Phone:252-241-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7924225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant