Healthcare Provider Details

I. General information

NPI: 1174385330
Provider Name (Legal Business Name): KELLY WALKER NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CAMPUS BLVD
WINCHESTER VA
22601-2800
US

IV. Provider business mailing address

324 N BRADDOCK ST
WINCHESTER VA
22601-3920
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-3044
  • Fax:
Mailing address:
  • Phone: 540-536-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3272631
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: