Healthcare Provider Details

I. General information

NPI: 1801010822
Provider Name (Legal Business Name): MRS. KIMBERLY KAY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 GILBERT RD.
RAVENNA OH
44266
US

IV. Provider business mailing address

9050 GILBERT RD.
RAVENNA OH
44266
US

V. Phone/Fax

Practice location:
  • Phone: 330-219-3194
  • Fax:
Mailing address:
  • Phone: 330-219-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number347E00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: