Provider Demographics
NPI:1104231513
Name:WALTERS, ASHLEY (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2013
Mailing Address - Country:US
Mailing Address - Phone:409-727-4422
Mailing Address - Fax:855-510-6580
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD STE 405
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2013
Practice Address - Country:US
Practice Address - Phone:409-727-4422
Practice Address - Fax:855-510-6580
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370183101Medicaid
TX394169YYSGMedicare PIN