Provider Demographics
NPI:1750628202
Name:WALTON, KEVIN LARON SR
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LARON
Last Name:WALTON
Suffix:SR
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 1:645 CHURCH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1712
Mailing Address - Country:US
Mailing Address - Phone:757-309-4688
Mailing Address - Fax:757-309-4689
Practice Address - Street 1:645 CHURCH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1712
Practice Address - Country:US
Practice Address - Phone:757-309-4688
Practice Address - Fax:757-309-4689
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide