Basic Information
| Provider Information | |||||||||
| NPI: | 1407311541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTON | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | AGNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 548 HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | HUEYTOWN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350231725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055679702 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 810 SAINT VINCENTS DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059302456 | ||||||||
| FaxNumber: | 2059302469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2019 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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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 | 363LA2200X | 1-129582 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163W00000X | 1-129582 | AL | N | Nursing Service Providers | Registered Nurse | 363LG0600X | 1-129582 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363L00000X | 1-129582 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1-129582 | 01 | AL | RN LICENSE NUMBER | OTHER | 7584 | 01 | AL | CRNP RX NUMBER | OTHER |