Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 002552 | GA |
N | 111NI0900X | Internist | 002552 | GA |
Y | 207RR0500X | Rheumatology | 22701 | MS |
NPI | 1013115906 |
---|---|
Provider Name | Dr. Nicole Roberts Walton |
First Address | Ocean Springs, MS 39564-5736 |
Second Address | Ocean Springs, MS 39564-5736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 09/05/2018 |