Individual
NICHOLAS DEAN WALTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32910
NE
207P00000X
Emergency Medicine Physician
Primary
71561
TN
208D00000X
General Practice Physician
32910
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/09/2019
Last updated
11/26/2024
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