Healthcare Provider Details

I. General information

NPI: 1205778776
Provider Name (Legal Business Name): KIARA WALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HOOVER ST
ANN ARBOR MI
48104
US

IV. Provider business mailing address

3132 GLAZIER WAY
ANN ARBOR MI
48105-2563
US

V. Phone/Fax

Practice location:
  • Phone: 616-427-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: