Provider Demographics
NPI:1710242458
Name:WALTON, TYRONGILIA QUEREESE (DNP)
Entity Type:Individual
Prefix:DR
First Name:TYRONGILIA
Middle Name:QUEREESE
Last Name:WALTON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 HIGHWAY 6 E
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-9213
Mailing Address - Country:US
Mailing Address - Phone:662-561-7671
Mailing Address - Fax:662-510-0192
Practice Address - Street 1:1450 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-9213
Practice Address - Country:US
Practice Address - Phone:662-561-7671
Practice Address - Fax:662-510-0192
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07630093Medicaid
MS272046ZWX3OtherMEDICARE