Provider Demographics
NPI:1811753908
Name:WALTERS, MARIA (ARPN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:ARPN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 HARRIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9036
Mailing Address - Country:US
Mailing Address - Phone:740-646-9574
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-0079
Practice Address - Fax:859-323-8173
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily