Provider Demographics
NPI:1063406130
Name:WALTERS, ASHLEY WOOD (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:WOOD
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 W CENTER RD
Mailing Address - Street 2:STE 211
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1900
Mailing Address - Country:US
Mailing Address - Phone:402-399-9305
Mailing Address - Fax:402-397-3191
Practice Address - Street 1:9239 W CENTER RD
Practice Address - Street 2:STE 211
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1900
Practice Address - Country:US
Practice Address - Phone:402-399-9305
Practice Address - Fax:402-397-3191
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE232112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07496OtherBCBS
NE07496OtherBCBS
NE278970Medicare ID - Type Unspecified