MEDICARE: MRS. ANDREA MEREDITH WALTERS MSN, 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	224070	LA

General Provider Information

NPI Number	:	1477201945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MEREDITH WALTERS MSN, APRN FNP-C

Provider Business Mailing Address
First Line	:	425 ASHLEY RIDGE BLVD STE 330C
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7226
Country	:	US
Telephone Number	:	318-399-7520
Fax Number	:	318-399-7521

Provider Business Practice Location Address
First Line	:	425 ASHLEY RIDGE BLVD STE 330C
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7226
Country	:	US
Telephone Number	:	318-399-7520
Fax Number	:	318-399-7521

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

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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