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General NPI Number Information
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NPI Number | 1285485698
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Entity Type | Organization
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Legal Business Name | YOUR WAY PEDIATRICS
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 360 TOWN PLAZA AVE STE 330
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5175
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Country | US
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Telephone | 904-419-9086
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Fax | 864-448-1482
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Provider Business Mailing Address
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Address Line | 360 TOWN PLAZA AVE STE 330
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5175
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Country | US
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Telephone | 904-419-9086
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Fax | 864-448-1482
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. CHRISTINA M RALKO
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Credential | APRN
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Telephone | 313-629-1552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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