Individual
MR. TIMOTHY P WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, RN, CPNP
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 623-6326
Mailing address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 623-6326
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
RN133867
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
133867
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669423976
—
MO
Enumeration date
05/12/2006
Last updated
06/30/2023
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