Provider Demographics
NPI:1780829846
Name:WALKER, KRISTIE LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 BENNINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6558
Mailing Address - Country:US
Mailing Address - Phone:760-637-5581
Mailing Address - Fax:
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-613-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist