Provider Demographics
NPI:1497958763
Name:WALTER, KRISTI ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANN
Last Name:WALTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-0939
Mailing Address - Country:US
Mailing Address - Phone:775-751-1349
Mailing Address - Fax:775-727-5551
Practice Address - Street 1:1601 E BASIN
Practice Address - Street 2:SUITE 302
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-4612
Practice Address - Country:US
Practice Address - Phone:775-751-1349
Practice Address - Fax:775-727-5551
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPSY0526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104252Medicare PIN