Provider Demographics
NPI:1558968503
Name:WALKER, VIVIAN KIMBLE
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:KIMBLE
Last Name:WALKER
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 1:3724 HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1120
Mailing Address - Country:US
Mailing Address - Phone:937-723-9781
Mailing Address - Fax:
Practice Address - Street 1:3724 HERMOSA DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45416-1120
Practice Address - Country:US
Practice Address - Phone:937-723-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services