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General NPI Number Information
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NPI Number | 1194140772
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Entity Type | Individual
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Provider Name | STEPHANIE PRATER WALTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 14607 WOODLAKE TRCE
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City | LOUISVILLE
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State | KY
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Zip | 40245-5134
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Country | US
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Telephone | 502-419-7136
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Fax |
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Provider Business Mailing Address
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Address Line | 14607 WOODLAKE TRCE
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City | LOUISVILLE
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State | KY
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Zip | 40245-5134
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Country | US
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Telephone | 502-419-7136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 28072
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 28072
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License Number State | KY
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