Individual
KENNETH WRAY WALCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1807 W PARK ROW DR, ARLINGTON, TX 76013-3585
(817) 299-9105
(817) 299-8845
Mailing address
PO BOX 173503, ARLINGTON, TX 76003-3503
(817) 299-9105
(817) 299-8845
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
238600
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238600
LIC #
TX
Enumeration date
10/19/2006
Last updated
07/21/2022
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