Provider Demographics
NPI:1972486066
Name:WALTMON, MYKALA
Entity type:Individual
Prefix:
First Name:MYKALA
Middle Name:
Last Name:WALTMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EAGLE NEST DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9435
Mailing Address - Country:US
Mailing Address - Phone:270-898-1293
Mailing Address - Fax:270-898-1187
Practice Address - Street 1:125 EAGLE NEST DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9435
Practice Address - Country:US
Practice Address - Phone:270-898-1187
Practice Address - Fax:270-898-1187
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator