Healthcare Provider Details

I. General information

NPI: 1386924926
Provider Name (Legal Business Name): KRISTEN LEIGH WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S TAMIAMI TRL STE 303
SARASOTA FL
34239-2921
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8791
  • Fax: 941-917-8793
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME144948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: