Connie Jo Walters, LPN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R054232 Issued in SD

Practice address

24276 166TH Street Airport Rd
Eagle Butte, SD 57625-1012

Phone

(605) 964-7724

NPI assigned

Mar 6, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1881134112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1012",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576251012",
            "telephone_number": "605-964-7724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24276 166TH STREET AIRPORT RD",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576251012",
            "telephone_number": "605-964-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "CONNIE JO",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SD",
            "license": "P012241",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SD",
            "license": "R054232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret L Upell, MD
• Candace Mae Veit, FNP-C
• Lisa M Veit, RN
• Mellissa Jo Vig
• Seth Volk
• Jastyn Blayne Ward
• Johnna Rae Watt, RN, BSN
• Matthew Watters, PHARMD
• Adrienne Coleen Widow
• Jauron Brandt Widow

• Registered Nurse in Eagle Butte, SD
• Providers in Eagle Butte, SD by specialty
• Registered Nurse in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.