Provider Demographics
NPI:1477083046
Name:WALKER, KATIE JO
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
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 1:22450 S HARRISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8882
Mailing Address - Country:US
Mailing Address - Phone:913-592-4149
Mailing Address - Fax:913-592-2107
Practice Address - Street 1:22450 S HARRISON ST STE 102
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-8882
Practice Address - Country:US
Practice Address - Phone:913-592-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS615261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice