Healthcare Provider Details

I. General information

NPI: 1104248913
Provider Name (Legal Business Name): KIMBERLY L. WALKER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BOWNESS WHNP-BC

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 10/13/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S 3RD ST
MONTROSE CO
81401-4209
US

IV. Provider business mailing address

715 S 3RD ST
MONTROSE CO
81401-4209
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-6737
  • Fax: 970-252-0112
Mailing address:
  • Phone: 970-249-6737
  • Fax: 970-252-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0992125-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: