Individual
KIMBERLY THERESA MCCLINTOCK-WALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
67 S MAIN ST, PEARL RIVER, NY 10965-2444
(845) 368-0800
(845) 368-0810
Mailing address
67 S MAIN ST, PEARL RIVER, NY 10965-2444
(845) 368-0800
(845) 368-0810
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
311577
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
311577
NY
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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