Healthcare Provider Details

I. General information

NPI: 1689528861
Provider Name (Legal Business Name): JOSEPH HARLEY WALTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RIVER ST STE A
FREMONT OH
43420-3586
US

IV. Provider business mailing address

1711 BUCKLAND AVE
FREMONT OH
43420-3566
US

V. Phone/Fax

Practice location:
  • Phone: 419-658-9989
  • Fax: 419-649-4454
Mailing address:
  • Phone: 419-658-9989
  • Fax: 419-649-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042474
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: