NPIMap

Organization Active NPI

Kelly M. Walker DPM,PLLC

  • Foot & Ankle Surgery Podiatrist
  • Dyersburg, TN
National Provider Identifier
1700109477
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
786 Issued in TN
Legal business name
KELLY M. WALKER DPM,PLLC
Practice address
1950 US Highway 51 Byp N
Suite C
Dyersburg, TN 38024-1897
Phone
(731) 325-5360
Fax
(731) 325-5365
NPI assigned
Mar 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Authorized official

Name
Dr. Kelly Michelle Walker, DPMNPI 1366499139
Title
Owner
Phone
(731) 325-5360

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 786 TN Primary

Addresses

Primary practice location

1950 US Highway 51 Byp N
Suite C
Dyersburg, TN 38024-1897

Mailing address

1950 US Highway 51 Byp N
Suite C
Dyersburg, TN 38024-1897
Phone (731) 325-5360

Other identifiers 2

IdentifierTypeStateIssuer
TXB107559OtherTXINDIVIDUAL PTAN
TXB107558OtherTXGROUP PTAN

Other names 1

  • WALKER FOOT AND ANKLE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161109002216 TN Part B Supplier - Clinic/Group Practice 6406970961 Receives reassigned benefits from 1 practitioner
Practice locations: Dyersburg, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1700109477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 US HIGHWAY 51 BYP N",
            "address_2": "SUITE C",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241897",
            "telephone_number": "731-325-5360",
            "fax_number": "731-325-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 US HIGHWAY 51 BYP N",
            "address_2": "SUITE C",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380241897",
            "telephone_number": "731-325-5360",
            "fax_number": "731-325-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY M. WALKER DPM,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-325-5360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TN",
            "license": "786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PTAN",
            "identifier": "TXB107559",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "TXB107558",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALKER FOOT AND ANKLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyersburg, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.