Provider Demographics
NPI:1891042040
Name:WALTERS, TONYA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-7597
Mailing Address - Country:US
Mailing Address - Phone:479-430-4790
Mailing Address - Fax:479-632-5600
Practice Address - Street 1:14 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3905
Practice Address - Country:US
Practice Address - Phone:866-538-9223
Practice Address - Fax:479-632-5600
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR84792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse