Organization
WALTON FAMILY CARE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYRONGILIA Q WALTON DNP (OWNER)
(662) 539-7383
Entity
Organization
Contact information
Practice address
228 STARLYN AVE, NEW ALBANY, MS 38652-2428
(662) 539-7383
(662) 539-7661
Mailing address
PO BOX 611, NEW ALBANY, MS 38652-0611
(662) 539-7383
(662) 539-7661
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871879
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07630093
—
MS
01
—
272046ZWX3
MEDICARE NUMBER
MS
Enumeration date
10/11/2016
Last updated
02/07/2017
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