Provider Demographics
NPI:1033416508
Name:WALKER, KIA TIYANNA
Entity Type:Individual
Prefix:DR
First Name:KIA
Middle Name:TIYANNA
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PARK AVE
Mailing Address - Street 2:ROOM #4
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5621
Mailing Address - Country:US
Mailing Address - Phone:914-299-4849
Mailing Address - Fax:
Practice Address - Street 1:396 ORANGE ST REAR BUILDING
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6443
Practice Address - Country:US
Practice Address - Phone:203-777-7911
Practice Address - Fax:203-777-7918
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000457175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath