Provider Demographics
NPI:1619595907
Name:WALTON, DONTA TAVON (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:DONTA
Middle Name:TAVON
Last Name:WALTON
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8114 SANDPIPER CIR STE 207
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5902
Mailing Address - Country:US
Mailing Address - Phone:443-854-1553
Mailing Address - Fax:833-973-4725
Practice Address - Street 1:8114 SANDPIPER CIR STE 207
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5902
Practice Address - Country:US
Practice Address - Phone:443-600-8178
Practice Address - Fax:833-973-4725
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR211890363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care