MEDICARE: MS. KIMBERLY ANN WALKER MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider		MI
2	372600000X	Adult Companion		MI

General Provider Information

NPI Number	:	1275131112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANN WALKER MA

Provider Business Mailing Address
First Line	:	452 BAY ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-1912
Country	:	US
Telephone Number	:	248-390-1430
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 BAY ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-1912
Country	:	US
Telephone Number	:	248-390-1430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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