Provider Demographics
NPI:1215369897
Name:WALKER, KRISTY R (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S DENMARK RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-9408
Mailing Address - Country:US
Mailing Address - Phone:440-858-9760
Mailing Address - Fax:
Practice Address - Street 1:1811 SOUTH DENMARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047
Practice Address - Country:US
Practice Address - Phone:440-858-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.14324-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse