Individual
STEPHANIE PRATER WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14607 WOODLAKE TRCE, LOUISVILLE, KY 40245-5134
(502) 419-7136
Mailing address
14607 WOODLAKE TRCE, LOUISVILLE, KY 40245-5134
(502) 419-7136
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
28072
KY
207RR0500X
Rheumatology Physician
28072
KY
Other
Enumeration date
02/19/2014
Last updated
02/19/2014
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