Healthcare Provider Details

I. General information

NPI: 1649888397
Provider Name (Legal Business Name): KASEY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ENCINA RD
GOLETA CA
93117-2269
US

IV. Provider business mailing address

5901 ENCINA RD
GOLETA CA
93117-2269
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-0035
  • Fax:
Mailing address:
  • Phone: 805-681-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95186143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: