Provider Demographics
NPI:1750881280
Name:WALTON, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:WALTON
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 211
Mailing Address - Street 2:
Mailing Address - City:WEESATCHE
Mailing Address - State:TX
Mailing Address - Zip Code:77993-0211
Mailing Address - Country:US
Mailing Address - Phone:361-491-0114
Mailing Address - Fax:
Practice Address - Street 1:800 N SHORELINE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3771
Practice Address - Country:US
Practice Address - Phone:361-882-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107417164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse