Active NPI
Kinyatta Walls
- Other Specialist/Technologist
- Dearborn, MI
National Provider Identifier
1376949024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- Practice address
- 3101 S Gulley Rd
Ste F
Dearborn, MI 48124-4406 - Phone
- (734) 407-2500
- NPI assigned
- Nov 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | Primary |
Addresses
Primary practice location
3101 S Gulley Rd
Ste F
Dearborn, MI 48124-4406
Mailing address
136 William St
Springfield, MA 01105-2324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Futures Healthcore, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Health Clinic/Center
- Dearborn, MI
- NPI 1164599544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415318400000",
"number": "1376949024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 WILLIAM ST",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011052324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3101 S GULLEY RD",
"address_2": "STE F",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244406",
"telephone_number": "734-407-2500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLS",
"first_name": "KINYATTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-07",
"last_updated": "2014-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.