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General NPI Number Information
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NPI Number | 1487073540
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Entity Type | Individual
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Provider Name | JESSICA LYNN WALTERS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3430 BURNET AVE
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City | CINCINNATI
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State | OH
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Zip | 45229-2833
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Country | US
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Telephone | 513-636-7722
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Fax | 513-636-3737
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Provider Business Mailing Address
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Address Line | 3430 BURNET AVE. ML 5026
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-7722
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Fax | 513-636-3737
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.131006
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License Number State | OH
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