Individual
KEONNA L WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5230 CAMPBELL BLVD, NOTTINGHAM, MD 21236-4983
(410) 933-9680
Mailing address
5230 CAMPBELL BLVD, NOTTINGHAM, MD 21236-4983
(410) 933-9680
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R212503
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209828800
—
MD
Enumeration date
12/12/2022
Last updated
11/02/2023
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