Individual
MIA MCKENZIE WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1455 VILLAGE CIRCLE DR, GLEN CARBON, IL 62034-4321
(618) 477-1810
Mailing address
6420 CLAYTON RD, SAINT LOUIS, MO 63117-1811
(314) 768-8360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2025038815
MO
Other
Enumeration date
05/14/2025
Last updated
11/24/2025
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