Provider Demographics
NPI:1851770523
Name:WALTER, JENNIFER LEE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:WALTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:303-764-6640
Practice Address - Street 1:410 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5659
Practice Address - Country:US
Practice Address - Phone:620-272-2579
Practice Address - Fax:620-272-2685
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76944-021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200631180AMedicaid
KS201123060AMedicaid
KS201123060AMedicaid