Provider Demographics
NPI:1962200907
Name:WALKER, JOHNNY B
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:B
Last Name:WALKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6258 S 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3824
Mailing Address - Country:US
Mailing Address - Phone:402-718-6359
Mailing Address - Fax:
Practice Address - Street 1:11340 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3815
Practice Address - Country:US
Practice Address - Phone:402-889-5686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver