Provider Demographics
NPI:1538368543
Name:WALTON, 1RODNEY DORNELL (BS)
Entity type:Individual
Prefix:
First Name:1RODNEY
Middle Name:DORNELL
Last Name:WALTON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BYRUM RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-8033
Mailing Address - Country:US
Mailing Address - Phone:870-532-2600
Mailing Address - Fax:
Practice Address - Street 1:397 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2241
Practice Address - Country:US
Practice Address - Phone:870-740-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator