Provider Demographics
NPI:1639268337
Name:WALTER, BRENDA (NNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 ALCOA HWY
Mailing Address - Street 2:SUITE 145
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1500
Mailing Address - Country:US
Mailing Address - Phone:865-305-6650
Mailing Address - Fax:865-305-5857
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:SUITE 145
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-6650
Practice Address - Fax:865-305-5857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN10603363LN0000X
TN86671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse