Healthcare Provider Details

I. General information

NPI: 1629102553
Provider Name (Legal Business Name): KAREN LEONE WALKER M.C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD 2645
OGDEN UT
84403-3271
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2880
  • Fax: 801-387-2885
Mailing address:
  • Phone: 801-387-2880
  • Fax: 801-387-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number110557-4101
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number11057-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: