Provider Demographics
NPI:1750861282
Name:WALTERS, NICOLE (DNP, PMHNP, RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DNP, PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 NATURES WAYE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-0567
Mailing Address - Country:US
Mailing Address - Phone:304-320-3538
Mailing Address - Fax:
Practice Address - Street 1:4555 NATURES WAYE RD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-0567
Practice Address - Country:US
Practice Address - Phone:304-320-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC228536163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty