Provider Demographics
NPI:1578718169
Name:WALTERS, JAMIE L (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:845 SIR THOMAS COURT
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109
Mailing Address - Country:US
Mailing Address - Phone:717-651-5800
Mailing Address - Fax:717-651-5808
Practice Address - Street 1:845 SIR THOMAS COURT
Practice Address - Street 2:SUITE 7
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-651-5800
Practice Address - Fax:717-651-5808
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003024L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant