Healthcare Provider Details

I. General information

NPI: 1942623178
Provider Name (Legal Business Name): IRENE WALTERS FAMILY PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MARCUS STREET SUITE C4
HAMILTON MT
59840
US

IV. Provider business mailing address

99 MARCUS STREET SUITE C4
HAMILTON MT
59840
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-7522
  • Fax: 406-375-7542
Mailing address:
  • Phone: 406-375-7522
  • Fax: 406-375-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRENE K WALTERS
Title or Position: OWNER/PROVIDER
Credential: APRN - FAMILY PSYCHI
Phone: 406-375-7522