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1275378291 NPI number — KIMBERLY PAIGE WALTER

NPI Number: 1275378291
Health Care Provider/Practitioner: KIMBERLY PAIGE WALTER

Information about “1275378291” NPI (KIMBERLY PAIGE WALTER) exists in 1275378291 in HTML format HTML  |  1275378291 in plain Text format TXT  |  1275378291 in PDF (Portable Document Format) PDF  |  1275378291 in an XML format XML  formats.

NPI Number : 1275378291 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275378291",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALTER",
    "FirstName": "KIMBERLY",
    "MiddleName": "PAIGE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WESTOVER",
    "OtherFirstName": "KIMBERLY",
    "OtherMiddleName": "PAIGE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4501 NETTLE CREEK CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ORANGE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32127-4909",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-316-6105",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "301 MEMORIAL MEDICAL PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTONA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32117-5167",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-231-6000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/01/2024",
    "LastUpdateDate": "06/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "246QM0706X",
        "TaxonomyName": "Medical Technologist",
        "LicenseNumber": "58528",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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