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General NPI Number Information
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NPI Number | 1780463646
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Entity Type | Individual
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Provider Name | TERESA ADRIANNE WALTY RN
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 5500 E KELLOGG DR
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City | WICHITA
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State | KS
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Zip | 67218-1607
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Country | US
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Telephone | 316-558-4968
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Fax | 316-651-2958
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Provider Business Mailing Address
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Address Line | 2110 TERRACE DR
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City | NEWTON
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State | KS
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Zip | 67114-1247
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Country | US
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Telephone | 316-371-0516
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 13-68501
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License Number State | KS
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