Provider Demographics
NPI:1275128159
Name:WALTON, SAMANTHA RACHEL (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RACHEL
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17175 N 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3929
Mailing Address - Country:US
Mailing Address - Phone:602-245-3987
Mailing Address - Fax:
Practice Address - Street 1:261 N ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2616
Practice Address - Country:US
Practice Address - Phone:480-305-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ255002363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care