# LACY DAWN DAVIS WALTERS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1659476737
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VG0400X | Gynecology Physician | PA622 | ID | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | PA622 | ID | — |
| 363A00000X | Physician Assistant | MED-PAC-LIC-26013 | MT | Yes |
| 363A00000X | Physician Assistant | PA-622 | ID | — |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 04/29/2021