MEDICARE: NIKKI ANDERSON WALDEN M.D.

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	174400000X	Specialist	L8999	TX
2	207V00000X	Obstetrics & Gynecology Physician	L8999	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0066MH	OTHER	TX	BLUE CROSS BLUE SHIELD
2	4732959	OTHER	TX	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	16244	OTHER	TX	PARKLAND
5	4501037598	OTHER	TX	CLIA
6	10016066	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1942210398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI ANDERSON WALDEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 118383
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75011-8383
Country	:	US
Telephone Number	:	972-820-9333
Fax Number	:	972-492-8600

Provider Business Practice Location Address
First Line	:	4325 N JOSEY LN
Second Line	:	SUITE 300
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4635
Country	:	US
Telephone Number	:	972-820-9333
Fax Number	:	972-492-8600

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	05/12/2008

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Directions to “ NIKKI ANDERSON WALDEN M.D.” Practice Location

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