Healthcare Provider Details

I. General information

NPI: 1891042040
Provider Name (Legal Business Name): TONYA WALTERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W CHERRY ST
ALMA AR
72921-3905
US

IV. Provider business mailing address

1504 SPRINGDALE DR
ALMA AR
72921-7597
US

V. Phone/Fax

Practice location:
  • Phone: 866-538-9223
  • Fax: 479-632-5600
Mailing address:
  • Phone: 479-430-4790
  • Fax: 479-632-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR84792
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: