Provider Demographics
NPI:1497498042
Name:WALTERS, KURSTYN RUSSELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:KURSTYN
Middle Name:RUSSELL
Last Name:WALTERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COTTONVALLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-6045
Mailing Address - Country:US
Mailing Address - Phone:256-746-1111
Mailing Address - Fax:
Practice Address - Street 1:1 COTTONVALLEY DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-6045
Practice Address - Country:US
Practice Address - Phone:256-746-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30177363LF0000X
AL1-135845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily