Provider Demographics
NPI:1194140772
Name:WALTON, STEPHANIE PRATER (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PRATER
Last Name:WALTON
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 1:14607 WOODLAKE TRCE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5134
Mailing Address - Country:US
Mailing Address - Phone:502-419-7136
Mailing Address - Fax:
Practice Address - Street 1:14607 WOODLAKE TRCE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5134
Practice Address - Country:US
Practice Address - Phone:502-419-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28072207RA0401X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology