Provider Demographics
NPI:1578168001
Name:WALKER WELLNESS LLC
Entity Type:Organization
Organization Name:WALKER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:406-200-8564
Mailing Address - Street 1:PO BOX 8684
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-1684
Mailing Address - Country:US
Mailing Address - Phone:406-200-8564
Mailing Address - Fax:
Practice Address - Street 1:110 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937
Practice Address - Country:US
Practice Address - Phone:406-200-8564
Practice Address - Fax:833-992-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477074003OtherINDIVIDUAL NPI