Provider Demographics
NPI:1235125048
Name:WALSTON, PATRICIA A (WHNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WALSTON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919B CHAMBERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2526
Mailing Address - Country:US
Mailing Address - Phone:502-349-1411
Mailing Address - Fax:502-349-0980
Practice Address - Street 1:919B CHAMBERS BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2526
Practice Address - Country:US
Practice Address - Phone:502-349-1411
Practice Address - Fax:502-349-0980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3347P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004850Medicaid
KY78004850Medicaid
KYP24682Medicare UPIN