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General NPI Number Information
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NPI Number | 1043663016
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE CARE OF FLOYD, LLC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 1069 TIMBERLINE RD SE
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City | COPPER HILL
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State | VA
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Zip | 24079-2729
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Country | US
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Telephone | 540-239-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 1069 TIMBERLINE RD SE
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City | COPPER HILL
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State | VA
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Zip | 24079-2729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JERUSALEM WALKER
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Credential | FNP-BC
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Telephone | 540-239-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024171212
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License Number State | VA
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