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NPI Code Detail

MEDICARE: DR. BREANNA JAMESON WALTERS MD

MEDICARE: DR. BREANNA JAMESON WALTERS MD
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
1207Q00000XFamily Medicine Physician149657FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922668300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BREANNA JAMESON WALTERS MD
Provider Business Mailing Address
First Line : 2140 CENTERVILLE RD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4314
Country : US
Telephone Number : 850-383-3311
Fax Number :
Provider Business Practice Location Address
First Line : 1491 GOVERNORS SQUARE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32301-3049
Country : US
Telephone Number : 850-383-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 12/17/2025

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