Provider Demographics
NPI:1922659408
Name:WALTON-SMITH, CATHY
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:WALTON-SMITH
Suffix:
Gender:F
Credentials:
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 1157
Mailing Address - Street 2:
Mailing Address - City:GRAND LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80447-1157
Mailing Address - Country:US
Mailing Address - Phone:970-531-3055
Mailing Address - Fax:
Practice Address - Street 1:271 GCR 4421, FS#1
Practice Address - Street 2:
Practice Address - City:GRAND LAKE
Practice Address - State:CO
Practice Address - Zip Code:80447
Practice Address - Country:US
Practice Address - Phone:970-531-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider