Provider Demographics
NPI:1427182559
Name:WALLS, KARA MCDONALD (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MCDONALD
Last Name:WALLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S FLOYD ST
Mailing Address - Street 2:SUITE 332
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3818
Mailing Address - Country:US
Mailing Address - Phone:502-852-3720
Mailing Address - Fax:502-852-3998
Practice Address - Street 1:571 S FLOYD ST
Practice Address - Street 2:SUITE 332
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3818
Practice Address - Country:US
Practice Address - Phone:502-852-3720
Practice Address - Fax:502-852-3998
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3986P363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012127Medicaid
KY0773304Medicare ID - Type Unspecified