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NPI Code Detail

MEDICARE: JUDY LYNN WALTON NP

MEDICARE: JUDY LYNN WALTON NP
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
1363L00000XNurse PractitionerAPN0000008467TN

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 : 1497748321
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY LYNN WALTON NP
Provider Business Mailing Address
First Line : 999 EXECUTIVE PARK BLVD
Second Line : SUITE 201
City : KINGSPORT
State : TN
Zip : 37660-4632
Country : US
Telephone Number : 423-224-3257
Fax Number : 423-224-3258
Provider Business Practice Location Address
First Line : 271 MEDICAL PARK BLVD
Second Line :
City : BRISTOL
State : TN
Zip : 37620-7455
Country : US
Telephone Number : 423-968-2311
Fax Number : 423-968-2312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 08/01/2012

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Directions to “ JUDY LYNN WALTON NP” Practice Location

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