Healthcare Provider Details

I. General information

NPI: 1154284115
Provider Name (Legal Business Name): KALEAH LANAE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W CAMELBACK RD
PHOENIX AZ
85017-3030
US

IV. Provider business mailing address

13033 RED VULCAN CT
CHARLOTTE NC
28213-4886
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-7500
  • Fax:
Mailing address:
  • Phone: 312-858-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: