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NPI Code Detail

MEDICARE: JESSICA ANNE WALLER

MEDICARE: JESSICA ANNE WALLER
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
1343900000XNon-emergency Medical Transport (VAN)AZ
2251E00000XHome Health AgencyAZ
3385H00000XRespite CareAZ

General Provider Information

NPI Number : 1619847175
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANNE WALLER
Provider Business Mailing Address
First Line : 2325 E CAMELBACK RD STE 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-3514
Country : US
Telephone Number : 602-782-5222
Fax Number : 480-900-8714
Provider Business Practice Location Address
First Line : 2325 E CAMELBACK RD STE 400
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-3514
Country : US
Telephone Number : 602-782-5222
Fax Number : 480-900-8714
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2025
Last Update Date : 01/26/2026

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