Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 28072 | KY |
N | 207RR0500X | Rheumatology | 28072 | KY |
NPI | 1194140772 |
---|---|
Provider Name | Stephanie Prater Walton |
First Address | Louisville, KY 40245-5134 |
Second Address | Louisville, KY 40245-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2014 |
Last Update Date | 19/02/2014 |