Basic Information
| Provider Information | |||||||||
| NPI: | 1083608095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | KAY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4403 HARRISON BLVD | ||||||||
| Address2: | STE 4640 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013874850 | ||||||||
| FaxNumber: | 8013874855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 E 3900 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841241286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012811300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 177304-1205 | UT | Y | Other Service Providers | Specialist |
No ID Information.