Provider Demographics
NPI:1275720658
Name:WALKER, KIMBERLY MICHELE (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELE
Other - Last Name:AUGUSTUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1901 E VOORHEES ST.
Mailing Address - Street 2:MS# 640- JAMIE MEDLEN
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834
Mailing Address - Country:US
Mailing Address - Phone:217-709-2204
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:6200 E. COLFAX AVE.
Practice Address - Street 2:HEALTHCARE CLINIC @ WALGREENS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:720-695-3099
Practice Address - Fax:303-377-3922
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0005308OtherAPN
CO1275720658OtherNPI