Provider Demographics
NPI:1295492338
Name:WALTER, JAMIE L
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:WALTER
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 1:8648 ARTHUR HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7424
Mailing Address - Country:US
Mailing Address - Phone:919-830-3303
Mailing Address - Fax:
Practice Address - Street 1:8648 ARTHUR HILLS CIR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7424
Practice Address - Country:US
Practice Address - Phone:919-830-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant