Provider Demographics
NPI:1215622931
Name:WALKER, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
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 1:1695 MESQUITE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5688
Mailing Address - Country:US
Mailing Address - Phone:928-453-0404
Mailing Address - Fax:928-855-2778
Practice Address - Street 1:1695 MESQUITE AVE STE 216
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5688
Practice Address - Country:US
Practice Address - Phone:928-453-0404
Practice Address - Fax:928-855-2778
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ213781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical