MEDICARE: DR. RICHELLE WALTER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP11003276	FL

General Provider Information

NPI Number	:	1215589551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHELLE WALTER APRN

Provider Business Mailing Address
First Line	:	PO BOX 748519
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8519
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:	904-376-3998

Provider Business Practice Location Address
First Line	:	900 BEACH BLVD STE 930
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4368
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	12/22/2025

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