Provider Demographics
NPI:1942513676
Name:WALTERS, LAURIE (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3552
Mailing Address - Country:US
Mailing Address - Phone:469-913-9400
Mailing Address - Fax:469-913-9420
Practice Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY STE 175
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3551
Practice Address - Country:US
Practice Address - Phone:214-635-5701
Practice Address - Fax:844-289-7691
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX300834402Medicaid
TX300834401Medicaid
TX300834402Medicaid
TXTXB144055Medicare PIN