Provider Demographics
NPI:1992199525
Name:WALKER, KHADIJAH ANN (RN)
Entity Type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 SEYMOUR AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2915
Mailing Address - Country:US
Mailing Address - Phone:845-616-1349
Mailing Address - Fax:845-616-1349
Practice Address - Street 1:675 3RD AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5704
Practice Address - Country:US
Practice Address - Phone:212-922-1001
Practice Address - Fax:212-922-0033
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688535-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse