Provider Demographics
NPI:1619470275
Name:WALTERS, HALEY (APRN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S THOMPSON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4261
Mailing Address - Country:US
Mailing Address - Phone:479-445-9900
Mailing Address - Fax:479-927-1829
Practice Address - Street 1:210 S THOMPSON ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4261
Practice Address - Country:US
Practice Address - Phone:479-445-9900
Practice Address - Fax:479-927-1829
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF01180875207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherNONE