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NPI Code Detail

MEDICARE: JENNIFER WALTERS PA-C

MEDICARE: JENNIFER WALTERS PA-C
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
1363A00000XPhysician AssistantPA866KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376528216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WALTERS PA-C
Provider Business Mailing Address
First Line : 4201 SPRINGHURST BLVD STE 102
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-6156
Country : US
Telephone Number : 25-156-0905
Fax Number : 502-883-0016
Provider Business Practice Location Address
First Line : 4201 SPRINGHURST BLVD STE 102
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-6156
Country : US
Telephone Number : 25-156-0905
Fax Number : 502-883-0016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 08/19/2025

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Directions to “ JENNIFER WALTERS PA-C” Practice Location

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