Cody Lee Walls, ATC, LAT, EMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT4598 Issued in TX

Practice address

4001 Summerhill Rd
Texarkana, TX 75503-2764

Phone

(903) 794-3891

NPI assigned

Oct 19, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Emergency Medical Technician

State licenses

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

{
    "created_epoch": "1350604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350604800000",
    "number": "1821341447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032764",
            "telephone_number": "903-794-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032764",
            "telephone_number": "903-794-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "CODY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT, EMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-19",
        "last_updated": "2012-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "TX",
            "license": "168141",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "AR",
            "license": "22756",
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "TX",
            "license": "1634643",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT4598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #06195)
• Walgreens Pharmacy
• Casey L Walker
• Sade Monchique Walker
• William Todd Wallace, PT
• Zachary David Walsh, PT
• Melissa Anne Ward-George, LPC
• Michael Layne Ward, DDS
• Robert Lloyd Ward, RPH
• Tammy Ward, CRNA

• Athletic Trainer in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.