Individual provider Active NPI

Johnetta J Walker

  • Prosthetics Case Management
  • Oakland, CA
National Provider Identifier
1174113138
Registry record updated Jan 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetics Case ManagementTaxonomy code 1744P3200X
License
KK300035 Issued in CA
Practice address
4152 Macarthur Blvd
Oakland, CA 94619-1906
Phone
(510) 812-2428
NPI assigned
Jan 24, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetics Case ManagementGroup: 193400000X SINGLE SPECIALTY GROUP 1744P3200X KK300035 CA Primary

Addresses

Primary practice location

4152 Macarthur Blvd
Oakland, CA 94619-1906

Mailing address

3542 Fruitvale Ave # 212
Oakland, CA 94602-2327
Phone (510) 812-2428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
KK300035CAMDProsthetics Case Management

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611446400000",
    "number": "1174113138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3542 FRUITVALE AVE # 212",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946022327",
            "telephone_number": "510-812-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946191906",
            "telephone_number": "510-812-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JOHNETTA",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-24",
        "last_updated": "2021-01-24",
        "certification_date": "2021-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "CA",
            "license": "KK300035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.