Provider Demographics
NPI:1043772932
Name:WALDEN, CONNESUALA (APRN)
Entity type:Individual
Prefix:
First Name:CONNESUALA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W PARK LOOP NW STE 360
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3042
Mailing Address - Country:US
Mailing Address - Phone:256-213-1400
Mailing Address - Fax:256-213-1462
Practice Address - Street 1:1241 PT MALLARD PKWY STE 410
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6572
Practice Address - Country:US
Practice Address - Phone:256-286-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health