Individual
MRS. CRYSTAL L WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C CNP
Contact information
Practice address
1136 JACKSON BLVD, RAPID CITY, SD 57702-4335
(605) 721-7246
(605) 341-4501
Mailing address
1136 JACKSON BLVD, RAPID CITY, SD 57702-4335
(605) 721-7246
(605) 341-4501
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0539
SD
208VP0014X
Interventional Pain Medicine Physician
0539
SD
363A00000X
Physician Assistant
0539
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0122934
MEDICA
SD
01
—
0539
DAKOTACARE
SD
01
—
119312100
WYOMING MEDICAID
SD
05
—
1518957133
—
SD
01
—
31781
SANFORD HEALTH PLAN
SD
01
—
41194500700
NEBRASKA MEDICAID
SD
01
—
4995927
WELLMARK BCBS
SD
Enumeration date
10/25/2005
Last updated
01/10/2011
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