Provider Demographics
NPI:1922046101
Name:WALTER, MEREDITH A (ADT NURSING PRAC ANP)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:A
Last Name:WALTER
Suffix:
Gender:F
Credentials:ADT NURSING PRAC ANP
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:A
Other - Last Name:NUCHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-729-0088
Mailing Address - Fax:314-729-0088
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-729-0088
Practice Address - Fax:314-729-0088
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146250363L00000X
IL041301761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7260711OtherAETNA
MO427262704Medicaid
MOSA56538OtherHEALTHCARE USA
IL04232002OtherBCBS
MO711678OtherHEALTHLINK
MO072357OtherEXCLUSIVE CHOICE
Q47054Medicare UPIN
ILK20137Medicare ID - Type Unspecified
MO826292159Medicare ID - Type Unspecified
MO427262704Medicaid
P00316512Medicare PIN