Provider Demographics
NPI:1619503547
Name:WALTERS, DESTINY DEONNA (PA)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:DEONNA
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1625
Practice Address - Street 1:855 SAM NEWELL RD STE 205
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-7664
Practice Address - Country:US
Practice Address - Phone:980-432-1027
Practice Address - Fax:980-432-1028
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1171842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant