Provider Demographics
NPI:1629387741
Name:WALTON, RONIQUE
Entity type:Individual
Prefix:
First Name:RONIQUE
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RONIQUE
Other - Middle Name:NESHELLE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:603 EDMONDS ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2033
Mailing Address - Country:US
Mailing Address - Phone:434-321-2804
Mailing Address - Fax:
Practice Address - Street 1:603 EDMONDS ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2033
Practice Address - Country:US
Practice Address - Phone:434-321-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA344600000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver