Provider Demographics
NPI:1366499139
Name:WALKER, KELLY MICHELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MICHELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:WALKER
Other - Last Name:BUKSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1950 US HIGHWAY 51 BYP N
Mailing Address - Street 2:SUITE C
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1896
Mailing Address - Country:US
Mailing Address - Phone:731-325-5360
Mailing Address - Fax:731-325-5365
Practice Address - Street 1:1950 US HIGHWAY 51 BYP N
Practice Address - Street 2:SUITE C
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1896
Practice Address - Country:US
Practice Address - Phone:731-325-5360
Practice Address - Fax:731-325-5365
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1843213ES0103X
KY446213ES0103X
TN786213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7694Medicare PIN
TX8F7694Medicare PIN