Individual
GEORGETTE WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4041 PRESTON HWY, LOUISVILLE, KY 40213-1601
(502) 375-3242
(502) 375-4331
Mailing address
PO BOX 950245, LOUISVILLE, KY 40295-0245
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
778P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009450
SIHO - NORTON ICC
KY
01
—
11480571
CAQH
—
05
—
78000064
—
KY
Enumeration date
07/25/2006
Last updated
04/27/2012
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