Provider Demographics
NPI:1578393997
Name:WALLS, KY'LEAH (BSW)
Entity type:Individual
Prefix:
First Name:KY'LEAH
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0197
Mailing Address - Country:US
Mailing Address - Phone:434-395-4973
Mailing Address - Fax:434-395-2969
Practice Address - Street 1:315 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1293
Practice Address - Country:US
Practice Address - Phone:434-395-4973
Practice Address - Fax:434-395-2969
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator