NPI 1114481868

Keith P Walters

Practitioner Prevention Professional Holland, MI

Practice location

Address: 370 Country Club Rd STE a, Holland, MI 49423-8303
Phone: (616) 836-2896

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence N438257 (MI)

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Registry record

NPI: 1114481868
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Jan 2019
Record last updated: 28 Jan 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.