Healthcare Provider Details

I. General information

NPI: 1770416992
Provider Name (Legal Business Name): CARMEN JEAN WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10040 I 10 SERVICE RD STE C
NEW ORLEANS LA
70127-2701
US

IV. Provider business mailing address

10040 I 10 SERVICE RD STE C
NEW ORLEANS LA
70127-2701
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-5220
  • Fax:
Mailing address:
  • Phone: 504-821-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: