Provider Demographics
NPI:1285299958
Name:WALTER, KALEY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:ANN
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-660-6950
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 860
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3573
Practice Address - Country:US
Practice Address - Phone:813-660-6950
Practice Address - Fax:813-660-6622
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant