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
1	363L00000X	Nurse Practitioner	APN0000008467	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID 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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