MEDICARE: MRS. DEBRA KAY WALTERS NPC

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	363LA2200X	Adult Health Nurse Practitioner	82294	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C99908	OTHER	CO	MEDICARE ID TYPE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82294	OTHER	CO	COLORADO LICENSE

General Provider Information

NPI Number	:	1548254105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA KAY WALTERS NPC

Provider Business Mailing Address
First Line	:	2709 N TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6231
Country	:	US
Telephone Number	:	719-473-0872
Fax Number	:	719-630-3658

Provider Business Practice Location Address
First Line	:	2709 N TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6231
Country	:	US
Telephone Number	:	719-473-0872
Fax Number	:	719-630-3658

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	10/23/2007

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