Provider Demographics
NPI:1922600782
Name:WALK, KIMBERLY JUNE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JUNE
Last Name:WALK
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 1:963B BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8832
Mailing Address - Country:US
Mailing Address - Phone:740-285-1312
Mailing Address - Fax:
Practice Address - Street 1:963B BULL RUN RD
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653-8832
Practice Address - Country:US
Practice Address - Phone:740-285-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2516870374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide