| Doctor Name: | KELLY WALKER |
| NPI Number: | 1659761054 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 4704309024 |
| Business Practice Address: | 8683 Red Arrow Hwy Watervliet, MI - 490989761 |
| Business Phone Number: | 3694633375 |
| Business Fax Number: | |
| Mailing Address: | 17335 Oleander Ave, TINLEY PARK |
| State: | IL |
| Postal Code: | 604773226 |
| Phone Number: | 7087100737 |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2015 |
| NPI Last Update Date: | 01/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704309024 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |