Provider Demographics
NPI:1578920450
Name:WALTERS, ANNA (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 FLOWOOD DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9303
Mailing Address - Country:US
Mailing Address - Phone:601-933-9521
Mailing Address - Fax:601-933-9525
Practice Address - Street 1:2550 FLOWOOD DR
Practice Address - Street 2:SUITE 400
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9303
Practice Address - Country:US
Practice Address - Phone:601-933-9521
Practice Address - Fax:601-933-9525
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901363367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07806574Medicaid
MS473166YPC0Medicare PIN