Provider Demographics
NPI:1780206797
Name:WALTON, KATIE MARIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MARIE
Last Name:WALTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N 13TH ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1958
Mailing Address - Country:US
Mailing Address - Phone:618-305-0438
Mailing Address - Fax:
Practice Address - Street 1:10420 OLD OLIVE STREET RD
Practice Address - Street 2:STE 205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5937
Practice Address - Country:US
Practice Address - Phone:314-692-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017037579163WP0808X
MO2020033934363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health