Provider Demographics
NPI:1225631609
Name:WALKER, KYLA SUSANN (LME, RMA)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:SUSANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LME, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 188TH ST SW STE 670
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4782
Mailing Address - Country:US
Mailing Address - Phone:206-209-0988
Mailing Address - Fax:206-209-0992
Practice Address - Street 1:3500 188TH ST SW STE 670
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4782
Practice Address - Country:US
Practice Address - Phone:206-209-0988
Practice Address - Fax:206-209-0992
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA113642208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery