Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mia McKenzie Walters, PA-C

Individual provider Physician Assistant · NPI 1801687355

Mia McKenzie Walters, PA-C is a Physician Assistant in Glen Carbon, Illinois. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Missouri.

Years since qualifying
1
Licensed in
MO
In the registry since
2025
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1455 Village Circle Dr
Glen Carbon, IL 62034-4321
Phone: (618) 477-1810
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2025038815 (MO)

Record details

NPI number1801687355
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMay 14, 2025
Last updated in NPPESNovember 24, 2025
Certification dateNovember 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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