Provider Demographics
NPI:1821306747
Name:WALTERS, REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:827 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8602
Mailing Address - Country:US
Mailing Address - Phone:281-356-2900
Mailing Address - Fax:281-356-5830
Practice Address - Street 1:827 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8602
Practice Address - Country:US
Practice Address - Phone:281-356-2900
Practice Address - Fax:281-356-5830
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX749450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily