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NPI Code Detail

MEDICARE: DR. RICHELLE WALTER APRN

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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP11003276FL

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 : 1361 13TH AVE S STE 270
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3258
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 : 03/04/2026

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