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General NPI Number Information
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NPI Number | 1750861282
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Entity Type | Individual
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Provider Name | NICOLE WALTERS DNP, PMHNP, RN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 4555 NATURES WAYE RD
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City | BLACKSBURG
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State | VA
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Zip | 24060-0567
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Country | US
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Telephone | 304-320-3538
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Fax |
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Provider Business Mailing Address
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Address Line | 4555 NATURES WAYE RD
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City | BLACKSBURG
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State | VA
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Zip | 24060-0567
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Country | US
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Telephone | 304-320-3538
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024176975
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 228536
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License Number State | SC
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