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General NPI Number Information
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NPI Number | 1730868191
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Entity Type | Individual
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Provider Name | NICKKI DAWN WALTER APRN-CNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 725 N GRAHAM ST STE 600
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City | STEPHENVILLE
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State | TX
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Zip | 76401-3100
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Country | US
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Telephone | 254-965-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 W SOUTH LOOP
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City | STEPHENVILLE
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State | TX
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Zip | 76401-5141
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1128678
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 922066
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License Number State | TX
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