Individual
JONATHAN WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4522
Mailing address
1737 BRIARCREST DR, SUITE 14, BRYAN, TX 77802-2769
(979) 776-4777
(979) 776-0588
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
72296
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1749756-01
—
TX
05
—
174975603
—
TX
01
—
822910
MEDICARE
TX
Enumeration date
09/01/2006
Last updated
05/12/2021
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