Provider Demographics
NPI:1104248913
Name:WALKER, KIMBERLY L (DNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BOWNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:715 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4209
Mailing Address - Country:US
Mailing Address - Phone:970-249-6737
Mailing Address - Fax:970-252-0112
Practice Address - Street 1:715 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4209
Practice Address - Country:US
Practice Address - Phone:970-249-6737
Practice Address - Fax:970-252-0112
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992125-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000192334Medicaid