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NPI Code Detail

MEDICARE: RICHARD LEE WALDEN CRNP

MEDICARE: RICHARD LEE WALDEN CRNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner905672MS
2363LP0808XPsychiatric/Mental Health Nurse Practitioner3-001136AL
3163WP0808XPsychiatric/Mental Health Registered NurseR895162MS

General Provider Information

NPI Number : 1992253082
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD LEE WALDEN CRNP
Provider Business Mailing Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number : 334-625-7602
Provider Business Practice Location Address
First Line : 7125 UNIVERSITY CT
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-8016
Country : US
Telephone Number : 334-239-2622
Fax Number : 334-625-7602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2016
Last Update Date : 11/21/2023

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