Healthcare Provider Details

I. General information

NPI: 1154917748
Provider Name (Legal Business Name): VITALITY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 SAINT JOHNS LN STE F
ELLICOTT CITY MD
21042-2600
US

IV. Provider business mailing address

5325 WOODLOT RD
COLUMBIA MD
21044-5721
US

V. Phone/Fax

Practice location:
  • Phone: 240-334-7650
  • Fax: 855-697-2497
Mailing address:
  • Phone: 717-497-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY CAMILLE WALKER
Title or Position: OWNER
Credential: MD
Phone: 717-497-4418