Provider Demographics
NPI:1588948574
Name:WALTER, CARLI NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:NICOLE
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8194 W DEER VALLEY RD # 106-264
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2127
Mailing Address - Country:US
Mailing Address - Phone:602-292-3703
Mailing Address - Fax:
Practice Address - Street 1:8325 W HAPPY VALLEY RD UNIT 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4361
Practice Address - Country:US
Practice Address - Phone:602-292-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4891363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical