MEDICARE: JANA WALKER

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1720675531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA WALKER

Provider Business Mailing Address
First Line	:	1131 AKE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8102
Country	:	US
Telephone Number	:	904-778-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	4736 AVENUE B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-3023
Country	:	US
Telephone Number	:	903-660-2157
Fax Number	:

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

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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Directions to “ JANA WALKER ” Practice Location

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