Provider Demographics
NPI:1609952696
Name:WALTON, PATRICK J (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:WALTON
Suffix:
Gender:M
Credentials:PA-C
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 11230
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1230
Mailing Address - Country:US
Mailing Address - Phone:479-709-7000
Mailing Address - Fax:479-709-7030
Practice Address - Street 1:3501 W E KNIGHT DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-1230
Practice Address - Country:US
Practice Address - Phone:479-709-7000
Practice Address - Fax:479-709-7030
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T0619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant