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General NPI Number Information
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NPI Number | 1548453673
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Entity Type | Individual
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Provider Name | KIM NMN WALKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 418 HOLMES POND RD
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City | JOHNSTON
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State | SC
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Zip | 29832-2688
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Country | US
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Telephone | 803-275-0933
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 611
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License Number State | SC
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