Provider Demographics
NPI:1649017807
Name:WALTERS, TERESA CANTRELL (FNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:CANTRELL
Last Name:WALTERS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 SYDENTON DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5627
Mailing Address - Country:US
Mailing Address - Phone:205-452-9789
Mailing Address - Fax:
Practice Address - Street 1:20 PINEGROVE BLVD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-1118
Practice Address - Country:US
Practice Address - Phone:205-452-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-168597163W00000X, 363LF0000X
PARN800330163W00000X
NY975616163W00000X
NY356260363LF0000X
PASP032543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse