Provider Demographics
NPI:1023382108
Name:WALKER, KAILI (PAC)
Entity type:Individual
Prefix:
First Name:KAILI
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:2550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8695
Practice Address - Country:US
Practice Address - Phone:616-252-5600
Practice Address - Fax:616-252-5600
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2017-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006287363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical