MEDICARE: KIMBERLY WALKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	21378	AZ

General Provider Information

NPI Number	:	1215622931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY WALKER

Provider Business Mailing Address
First Line	:	1695 MESQUITE AVE STE 216
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5688
Country	:	US
Telephone Number	:	928-453-0404
Fax Number	:	928-855-2778

Provider Business Practice Location Address
First Line	:	1695 MESQUITE AVE STE 216
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5688
Country	:	US
Telephone Number	:	928-453-0404
Fax Number	:	928-855-2778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	02/22/2024

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Directions to “ KIMBERLY WALKER ” Practice Location

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