Individual
DORTHIA S WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
106 WALKER ST, HOULKA, MS 38850-9453
(662) 568-3316
(662) 568-3360
Mailing address
PO BOX 187, HOULKA, MS 38850-0187
(662) 568-3316
(662) 568-3360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R573388
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07770365
—
MS
Enumeration date
07/27/2006
Last updated
01/14/2016
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