MEDICARE: MRS. PASTELLE HENRY WALSTON APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN242754	GA

General Provider Information

NPI Number	:	1316341951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PASTELLE HENRY WALSTON APRN, FNP-C

Provider Business Mailing Address
First Line	:	1287 MARKS CHURCH ROAD
Second Line	:	SUITE B
City	:	AUGUSTA
State	:	GA
Zip	:	30909
Country	:	US
Telephone Number	:	706-739-5859
Fax Number	:	706-410-2125

Provider Business Practice Location Address
First Line	:	1287 MARKS CHURCH ROAD
Second Line	:	SUITE B
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2497
Country	:	US
Telephone Number	:	706-739-5859
Fax Number	:	706-410-2125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	03/17/2026

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