Healthcare Provider Details

I. General information

NPI: 1639187859
Provider Name (Legal Business Name): KRISTEN V WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3573 SW CORPORATE PKWY
PALM CITY FL
34990-8153
US

IV. Provider business mailing address

3573 SW CORPORATE PKWY
PALM CITY FL
34990-8153
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-5431
  • Fax: 772-283-5471
Mailing address:
  • Phone: 772-283-5431
  • Fax: 772-283-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME69055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: