Basic Information
| Provider Information | |||||||||
| NPI: | 1750334975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1098 | ||||||||
| Address2: | ST. CLAIRE FAMILY MEDICINE EXPRESS | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403515098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067836400 | ||||||||
| FaxNumber: | 6067836847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1028 E MAIN ST | ||||||||
| Address2: | ST. CLAIRE FAMILY MEDICINE EXPRESS | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067836400 | ||||||||
| FaxNumber: | 6067836847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3003584 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 78017126 | 05 | KY | MEDICAID |