Provider Demographics
NPI:1770184681
Name:WALTERS, MADISON (CNP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2004
Mailing Address - Country:US
Mailing Address - Phone:614-499-4447
Mailing Address - Fax:
Practice Address - Street 1:5888 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2860
Practice Address - Country:US
Practice Address - Phone:614-882-4343
Practice Address - Fax:614-882-4664
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027955363LP0808X
OHAPRN.CNP.002795363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health