1497930564 NPI number — DR. KRISTEN ANN WALTERS D.C.

Table of content: DR. KRISTEN ANN WALTERS D.C. (NPI 1497930564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497930564 NPI number — DR. KRISTEN ANN WALTERS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
KRISTEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497930564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 CENTRAL PKWY N
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-5052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-404-6050
Provider Business Mailing Address Fax Number:
866-313-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-386-1693
Provider Business Practice Location Address Fax Number:
866-313-3397
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  0104557001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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