Provider Demographics
NPI:1073933305
Name:WALTON, MARIAH A (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:A
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6812
Mailing Address - Country:US
Mailing Address - Phone:940-484-1887
Mailing Address - Fax:940-591-0458
Practice Address - Street 1:3303 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6812
Practice Address - Country:US
Practice Address - Phone:940-484-1887
Practice Address - Fax:940-591-0458
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily