Healthcare Provider Details

I. General information

NPI: 1750319653
Provider Name (Legal Business Name): KATHEY J WALSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 N MERIDIAN ST # 200
INDIANAPOLIS IN
46290-1152
US

IV. Provider business mailing address

10601 N MERIDIAN ST # 200
INDIANAPOLIS IN
46290-1152
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-2700
  • Fax: 317-575-2713
Mailing address:
  • Phone: 317-575-2700
  • Fax: 317-575-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28137795
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: