Provider Demographics
NPI:1316348303
Name:WALKER, KRISTIN
Entity type:Individual
Prefix:
First Name:KRISTIN
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 1:1236 LINCOLN AVE
Mailing Address - Street 2:EVANSVILLE
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1056
Mailing Address - Country:US
Mailing Address - Phone:812-422-8555
Mailing Address - Fax:
Practice Address - Street 1:4614 84TH ST
Practice Address - Street 2:URBANDALE
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-1089
Practice Address - Country:US
Practice Address - Phone:515-270-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073616225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant