Provider Demographics
NPI:1578038386
Name:WALTER, CAREY MADISON (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:MADISON
Last Name:WALTER
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:M
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 AXUM RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9172
Mailing Address - Country:US
Mailing Address - Phone:336-339-3008
Mailing Address - Fax:
Practice Address - Street 1:7565 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32119367500000X
NC246655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered