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General NPI Number Information
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NPI Number | 1285137380
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Entity Type | Individual
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Provider Name | KAMIKA WALL
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Gender | Female
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 7040 WIND STONE BLVD STE 150
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9090
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Country | US
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Telephone | 662-874-5828
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Fax | 662-874-5870
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | CORDOVA
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State | TN
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Zip | 38088-0515
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Country | US
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Telephone | 901-484-9099
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Fax | 470-222-2771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 905658
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 24058
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 169468
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 24058
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 916499
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License Number State | MS
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