Healthcare Provider Details

I. General information

NPI: 1730609140
Provider Name (Legal Business Name): KIMBERLY C. WALKER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 313
COLUMBIA MD
21044-6216
US

IV. Provider business mailing address

5325 WOODLOT RD
COLUMBIA MD
21044-5721
US

V. Phone/Fax

Practice location:
  • Phone: 240-334-7650
  • Fax: 866-700-7059
Mailing address:
  • Phone: 717-497-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberD0073253
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberD0073253
License Number StateMD

VIII. Authorized Official

Name: DR. KIMBERLY CAMILLE WALKER
Title or Position: OWNER
Credential: MD
Phone: 240-334-7650