MEDICARE: MS. PATTIE N WALTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	400461-1	NY
2	363LF0000X	Family Nurse Practitioner	F334488-1	NY

General Provider Information

NPI Number	:	1164670303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATTIE N WALTON FNP

Provider Business Mailing Address
First Line	:	255 SEA CLIFF ST
Second Line	:
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1106
Country	:	US
Telephone Number	:	631-650-5964
Fax Number	:	631-650-5964

Provider Business Practice Location Address
First Line	:	445 PARK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-2735
Country	:	US
Telephone Number	:	718-963-0800
Fax Number	:	718-534-5221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	01/09/2020

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