Provider Demographics
NPI:1427445568
Name:WALKER, KRISTEN NICOLE (MD)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SOUTH CLINTON AVE
Mailing Address - Street 2:BLDG H, STE 230
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-341-7200
Mailing Address - Fax:585-325-6052
Practice Address - Street 1:2400 SOUTH CLINTON AVE
Practice Address - Street 2:BLDG H, STE 230
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-341-7200
Practice Address - Fax:585-325-6052
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291792207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine