Healthcare Provider Details

I. General information

NPI: 1811050909
Provider Name (Legal Business Name): JUDITH ANN WALTERS DNP, APRN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 SE 47TH ST STE 112
CAPE CORAL FL
33904-9602
US

IV. Provider business mailing address

1222 SE 47TH ST STE 112
CAPE CORAL FL
33904-9602
US

V. Phone/Fax

Practice location:
  • Phone: 239-448-5959
  • Fax: 239-946-0232
Mailing address:
  • Phone: 239-448-4949
  • Fax: 239-946-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number484602
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS9349898
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN9349898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: