Healthcare Provider Details

I. General information

NPI: 1891158333
Provider Name (Legal Business Name): KIRBY R. WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OSPREY BLVD STE 205
BARTOW FL
33830-4347
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-519-1799
  • Fax: 863-229-7550
Mailing address:
  • Phone: 727-532-0002
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME179029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: