Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 138032 | CA |
Y | 208800000X | Urologist | 73658 | WI |
NPI | 1063839512 |
---|---|
Provider Name | Kelly Ashton Walker |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2014 |
Last Update Date | 21/07/2020 |