Provider Demographics
NPI:1184211120
Name:WALKER-BEAN, KIMBERLY NICOLE (RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:WALKER-BEAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 S LIONS GATE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7800
Mailing Address - Country:US
Mailing Address - Phone:901-299-0012
Mailing Address - Fax:
Practice Address - Street 1:2115 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4233
Practice Address - Country:US
Practice Address - Phone:901-274-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210743163WP2201X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care