Provider Demographics
NPI:1326325275
Name:WALKER-HENLEY, KIMBLY
Entity Type:Individual
Prefix:
First Name:KIMBLY
Middle Name:
Last Name:WALKER-HENLEY
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 1:501 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1019
Mailing Address - Country:US
Mailing Address - Phone:706-724-1883
Mailing Address - Fax:706-724-2494
Practice Address - Street 1:501 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1019
Practice Address - Country:US
Practice Address - Phone:706-724-1883
Practice Address - Fax:706-724-2494
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10915183500000X
GA21826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist