Healthcare Provider Details

I. General information

NPI: 1073852604
Provider Name (Legal Business Name): KARA D. WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S NATIONAL AVE
SPRINGFIELD MO
65807-7310
US

IV. Provider business mailing address

2030 OLDE GATE RD
NIXA MO
65714-7460
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3246
  • Fax: 417-875-3810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2013002724
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: