Provider Demographics
NPI:1730173790
Name:WALKER, KELLEY DENISE (MD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:DENISE
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 1:10241 KINGSTON PIKE
Mailing Address - Street 2:SUITE 1 AND 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3240
Mailing Address - Country:US
Mailing Address - Phone:865-691-1165
Mailing Address - Fax:865-690-6042
Practice Address - Street 1:10241 KINGSTON PIKE
Practice Address - Street 2:SUITE 1 AND 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3240
Practice Address - Country:US
Practice Address - Phone:865-691-1165
Practice Address - Fax:865-690-6042
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000214592084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34415Medicare UPIN