Provider Demographics
NPI:1295546786
Name:WALKER, KEYUANA
Entity type:Individual
Prefix:
First Name:KEYUANA
Middle Name:
Last Name:WALKER
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 1:3806 N BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-4827
Mailing Address - Country:US
Mailing Address - Phone:317-489-1976
Mailing Address - Fax:317-981-1169
Practice Address - Street 1:3806 N BOLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4827
Practice Address - Country:US
Practice Address - Phone:317-489-1976
Practice Address - Fax:317-981-1169
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23-016592-13747A0650X
IN23-0165923747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider