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NPI Code Detail

MEDICARE: MRS. RENADA CAPRICE WALTON FNP-C

MEDICARE: MRS. RENADA CAPRICE WALTON 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
1363LF0000XFamily Nurse Practitioner71015088AIN

General Provider Information

NPI Number : 1346000957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RENADA CAPRICE WALTON FNP-C
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number : 317-621-7584
Fax Number :
Provider Business Practice Location Address
First Line : 6191 N KEYSTONE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-2423
Country : US
Telephone Number : 317-257-6746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2024
Last Update Date : 12/11/2024

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