Provider Demographics
NPI:1962151431
Name:WALKER, JOHNATHONY
Entity type:Individual
Prefix:
First Name:JOHNATHONY
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:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-739-6818
Mailing Address - Fax:
Practice Address - Street 1:205 INGRAM BLVD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3423
Practice Address - Country:US
Practice Address - Phone:870-739-6818
Practice Address - Fax:870-662-6826
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator