Healthcare Provider Details

I. General information

NPI: 1699366252
Provider Name (Legal Business Name): RACHEL ELAINE WALTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 HURST DR
MATTOON IL
61938-9200
US

IV. Provider business mailing address

987 CR 1100N
SULLIVAN IL
61951-6318
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-7590
  • Fax: 217-258-3686
Mailing address:
  • Phone: 217-254-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: