Provider Demographics
NPI:1811500010
Name:WALTERS, NYCOL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:NYCOL
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 HUMMINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9542
Mailing Address - Country:US
Mailing Address - Phone:509-967-2060
Mailing Address - Fax:
Practice Address - Street 1:2600 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4108
Practice Address - Country:US
Practice Address - Phone:509-547-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer