Provider Demographics
NPI:1619157336
Name:WALTON, GWENITA A (CBHT)
Entity Type:Individual
Prefix:MRS
First Name:GWENITA
Middle Name:A
Last Name:WALTON
Suffix:
Gender:F
Credentials:CBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVENUE F NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-385-5179
Mailing Address - Fax:863-385-4678
Practice Address - Street 1:5825 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1216
Practice Address - Country:US
Practice Address - Phone:863-385-5179
Practice Address - Fax:863-385-4678
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker