Provider Demographics
NPI:1235416272
Name:WALTER, EMILY GIBSON (ANP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GIBSON
Last Name:WALTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:7780 BRIER CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7869
Practice Address - Country:US
Practice Address - Phone:919-596-3400
Practice Address - Fax:919-596-3499
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005391363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health