Healthcare Provider Details

I. General information

NPI: 1720402878
Provider Name (Legal Business Name): KATHRYN PELLEGRINO WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1621
  • Fax:
Mailing address:
  • Phone: 202-877-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: