Provider Demographics
NPI:1801383963
Name:WALTON, KATHLEEN B (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:B
Last Name:WALTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 E CODY AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2231
Mailing Address - Country:US
Mailing Address - Phone:480-620-5821
Mailing Address - Fax:
Practice Address - Street 1:3636 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0514
Practice Address - Country:US
Practice Address - Phone:928-757-3636
Practice Address - Fax:928-757-7224
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10917363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care