Provider Demographics
NPI:1427333434
Name:WALTON, SHARONDA LAVETTE (ANP-BC)
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:LAVETTE
Last Name:WALTON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 DEOLA DOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6532
Mailing Address - Country:US
Mailing Address - Phone:901-219-8378
Mailing Address - Fax:
Practice Address - Street 1:3835 DEOLA DOBBINS RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6532
Practice Address - Country:US
Practice Address - Phone:901-219-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015532363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health