Provider Demographics
NPI:1265698609
Name:WALTER, KATHRYN ANNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANNA
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8690 JAFFA COURT WEST DR APT 33
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5334
Mailing Address - Country:US
Mailing Address - Phone:317-844-6609
Mailing Address - Fax:
Practice Address - Street 1:7950 N SHADELAND AVE STE 350
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2699
Practice Address - Country:US
Practice Address - Phone:317-578-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN99033355A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical