Provider Demographics
NPI:1720723760
Name:WALKER, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
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 1:2755 PHILMONT AVE SUITE 115
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-947-4100
Mailing Address - Fax:215-947-0192
Practice Address - Street 1:2755 PHILMONT AVE SUITE 115
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-947-4100
Practice Address - Fax:215-947-0192
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN293806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse