Healthcare Provider Details

I. General information

NPI: 1023066172
Provider Name (Legal Business Name): NITA WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9275 MONTGOMERY RD STE 200
CINCINNATI OH
45242-7779
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-4510
  • Fax: 513-936-4511
Mailing address:
  • Phone: 513-585-5501
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-061801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: