Provider Demographics
NPI:1366295313
Name:WALTERS, TIFFANI ANNE MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:ANNE MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4795
Mailing Address - Country:US
Mailing Address - Phone:304-422-7300
Mailing Address - Fax:304-428-3719
Practice Address - Street 1:936 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4795
Practice Address - Country:US
Practice Address - Phone:304-422-7300
Practice Address - Fax:304-428-3719
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV119044364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health