1184622888 NPI number — DR. KATHERINE LYNN WALKER M.D.

Table of content: DR. KATHERINE LYNN WALKER M.D. (NPI 1184622888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184622888 NPI number — DR. KATHERINE LYNN WALKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
KATHERINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184622888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 COLE BLVD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
GOLDEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80401-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-763-4900
Provider Business Mailing Address Fax Number:
303-763-5495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 79TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NIWOT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80503-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-494-7100
Provider Business Practice Location Address Fax Number:
303-652-0518
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  40593 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86286773 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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