Individual
KELLY MICHELLE WALTHIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2840 E SKYLINE DR STE 230, TUCSON, AZ 85718-8005
(520) 324-1214
(520) 324-1281
Mailing address
PO BOX 31235, TUCSON, AZ 85751-1235
(520) 324-2308
(520) 324-1406
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
009999
AZ
207Q00000X
Family Medicine Physician
S6090
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009999
STATE LICENSE
AZ
Enumeration date
04/24/2017
Last updated
12/01/2023
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