MEDICARE: MS. KIMBERLY WALL CRT

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	2471C1101X	Cardiovascular-Interventional Technology Radiologic Technologist	38069	FL
2	3747P1801X	Personal Care Attendant		FL

General Provider Information

NPI Number	:	1346173788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY WALL CRT

Provider Business Mailing Address
First Line	:	5090 35TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2122
Country	:	US
Telephone Number	:	727-608-7497
Fax Number	:

Provider Business Practice Location Address
First Line	:	5090 35TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2122
Country	:	US
Telephone Number	:	727-608-7497
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/18/2026

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