Healthcare Provider Details

I. General information

NPI: 1487073540
Provider Name (Legal Business Name): JESSICA LYNN WALTERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVE
CINCINNATI OH
45229-2833
US

IV. Provider business mailing address

3430 BURNET AVE. ML 5026
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7722
  • Fax: 513-636-3737
Mailing address:
  • Phone: 513-636-7722
  • Fax: 513-636-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.131006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: