Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | A070139 | IA |
NPI | 1194770693 |
---|---|
Provider Name | Mrs. Kimberlee A Walker |
First Address | Ottumwa, IA 52501-2924 |
Second Address | Ottumwa, IA 52501-2924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0221176 | (05) | IA |
42935 | BLUE CROSS BLUE SHIELD (01) | IA |
I7333 | (02) | IA |