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General NPI Number Information
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NPI Number | 1780206797
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Entity Type | Individual
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Provider Name | KATIE MARIE WALTON APRN
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Gender | Female
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 10420 OLD OLIVE STREET RD STE 205
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City | SAINT LOUIS
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State | MO
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Zip | 63141-5937
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Country | US
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Telephone | 314-692-8516
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N 13TH ST APT 4H
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1958
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Country | US
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Telephone | 618-305-0438
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2017037579
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2020033934
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License Number State | MO
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