Provider Demographics
NPI:1801357769
Name:WALTON, KARISSA JEAN (NMD)
Entity Type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:JEAN
Last Name:WALTON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3002
Mailing Address - Country:US
Mailing Address - Phone:928-298-3349
Mailing Address - Fax:
Practice Address - Street 1:140 N GRANITE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3002
Practice Address - Country:US
Practice Address - Phone:928-298-3349
Practice Address - Fax:928-298-6133
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1781175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath