Provider Demographics
NPI:1568177699
Name:WALTERS, ABIGAIL CHRISTINE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CHRISTINE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 HEATHERY WAY
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4973
Mailing Address - Country:US
Mailing Address - Phone:630-841-2229
Mailing Address - Fax:
Practice Address - Street 1:8335 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-2041
Practice Address - Country:US
Practice Address - Phone:816-741-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021038822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist