Provider Demographics
NPI:1093442873
Name:WALTON, KENNEDY NICOLE
Entity Type:Individual
Prefix:MS
First Name:KENNEDY
Middle Name:NICOLE
Last Name:WALTON
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 1:2700 BRAZOS ST APT 4321
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2264
Mailing Address - Country:US
Mailing Address - Phone:205-526-5579
Mailing Address - Fax:
Practice Address - Street 1:2700 BRAZOS ST APT 4321
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2264
Practice Address - Country:US
Practice Address - Phone:205-526-5579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program