Individual
THOMAS M WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5166
Mailing address
15 AVERY KNLS, HATTIESBURG, MS 39402-8131
(601) 297-6283
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R717886
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114837
—
MS
05
—
1501859
—
LA
Enumeration date
07/21/2006
Last updated
01/25/2024
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