Healthcare Provider Details

I. General information

NPI: 1376182345
Provider Name (Legal Business Name): KAYLYN R WALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CHESTNUT ST
MOUNT VERNON OH
43050-3404
US

IV. Provider business mailing address

1106 HOMER RD NW
UTICA OH
43080-9589
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-9255
  • Fax:
Mailing address:
  • Phone: 740-616-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: