MEDICARE: MRS. JODI KAY WALTHER NP-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
1	363LF0000X	Family Nurse Practitioner	A-119541	IA

General Provider Information

NPI Number	:	1932456035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODI KAY WALTHER NP-C

Provider Business Mailing Address
First Line	:	4612 PRAIRIE PKWY STE 100
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7971
Country	:	US
Telephone Number	:	319-234-4431
Fax Number	:	319-222-2705

Provider Business Practice Location Address
First Line	:	4612 PRAIRIE PKWY STE 100
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-7971
Country	:	US
Telephone Number	:	319-234-4431
Fax Number	:	319-222-2705

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	07/21/2022

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