Individual provider Active NPI

Tiffany Elizabeth Walters, APRN

  • Women's Health Nurse Practitioner
  • Live Oak, TX
National Provider Identifier
1417795451
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
1228890 Issued in TX
Practice address
12500 Judson Rd Ste 210
Live Oak, TX 78233-4146
Phone
(210) 878-0090
NPI assigned
Jul 15, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 1228890 TX Primary

Addresses

Primary practice location

12500 Judson Rd Ste 210
Live Oak, TX 78233-4146

Mailing address

12500 Judson Rd Ste 210
Live Oak, TX 78233-4146
Phone (210) 878-0090

Other names 1

  • Tiffany Elizabeth Dunlap Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260513000784 TX Practitioner - Nurse Practitioner 6305315904

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Methodist Physician Practices PLLCGroup PAC ID 8022171974, 176 clinicians

Practice addresses (Care Compare)

12500 Judson Rd
Suite 210
Live Oak, TX 78233-4146
Phone (210) 878-0090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1228890TXMDWomen's Health Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777248000000",
    "number": "1417795451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12500 JUDSON RD STE 210",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782334146",
            "telephone_number": "210-878-0090",
            "fax_number": "210-878-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 JUDSON RD STE 210",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782334146",
            "telephone_number": "210-878-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "TIFFANY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-15",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "1228890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "DUNLAP",
            "middle_name": "ELIZABETH",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Live Oak, TX

Sources for this page

Verify at the official NPI Registry.