Healthcare Provider Details

I. General information

NPI: 1477201945
Provider Name (Legal Business Name): ANDREA MEREDITH WALTERS MSN, APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ASHLEY RIDGE BLVD STE 330C
SHREVEPORT LA
71106-7226
US

IV. Provider business mailing address

425 ASHLEY RIDGE BLVD STE 330C
SHREVEPORT LA
71106-7226
US

V. Phone/Fax

Practice location:
  • Phone: 318-399-7520
  • Fax: 318-399-7521
Mailing address:
  • Phone: 318-399-7520
  • Fax: 318-399-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number224070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: