Kellie Walker, RN

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

R211842-4 Issued in MN

Practice address

6832 S East Lake Blvd
Lake Nebagamon, WI 54849-9107

Phone

(218) 355-8268

NPI assigned

Jun 12, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1083398929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6832 S EAST LAKE BLVD",
            "city": "LAKE NEBAGAMON",
            "state": "WI",
            "postal_code": "548499107",
            "telephone_number": "218-355-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6832 S EAST LAKE BLVD",
            "city": "LAKE NEBAGAMON",
            "state": "WI",
            "postal_code": "548499107",
            "telephone_number": "218-355-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "KELLIE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "WI",
            "license": "195210-30",
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MN",
            "license": "R211842-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Renee May
• Michael R Lawler DDS SC
• Lauren Poppe, DDS
• Justine Reijo, RD
• Laura Star

• Medical-Surgical Registered Nurse in Lake Nebagamon, WI
• Providers in Lake Nebagamon, WI by specialty
• Medical-Surgical Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.