Healthcare Provider Details

I. General information

NPI: 1770502288
Provider Name (Legal Business Name): ROY P WALTON CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BELLEFONTAINE AVE
LIMA OH
45804-3121
US

IV. Provider business mailing address

5222 SPENCERVILLE RD
LIMA OH
45805-4230
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-5788
  • Fax: 419-222-9504
Mailing address:
  • Phone: 419-222-5788
  • Fax: 419-222-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-04248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: