Individual
KATIE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 S 70TH ST, FORT SMITH, AR 72903-5017
(903) 749-1755
Mailing address
1014 RED OAK ST, ELKINS, AR 72727-7201
(903) 749-1755
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
227616
AR
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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