Healthcare Provider Details

I. General information

NPI: 1083608095
Provider Name (Legal Business Name): KAY B WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E 3900 S
SALT LAKE CITY UT
84124-1286
US

IV. Provider business mailing address

4403 HARRISON BLVD STE 4640
OGDEN UT
84403-3304
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-1300
  • Fax:
Mailing address:
  • Phone: 801-387-4850
  • Fax: 801-387-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number177304-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: