Basic Information
| Provider Information | |||||||||
| NPI: | 1932685344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALDEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9027 OAK HAVEN DR | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374212078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235445084 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2205 MCCALLIE AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236982435 | ||||||||
| FaxNumber: | 4236976173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2018 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN0000195463 | TN | Y | Nursing Service Providers | Registered Nurse |
No ID Information.