MEDICARE: MRS. HERMONYONE WALKER CERTIFIED MENTAL HEA

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	104100000X	Social Worker	50412CMPH	FL

General Provider Information

NPI Number	:	1992907703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HERMONYONE WALKER CERTIFIED MENTAL HEA

Provider Business Mailing Address
First Line	:	12565 WILLARD LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2335
Country	:	US
Telephone Number	:	904-768-9829
Fax Number	:	904-765-0489

Provider Business Practice Location Address
First Line	:	6140 CLEVELAND RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-1904
Country	:	US
Telephone Number	:	904-859-8251
Fax Number	:

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/08/2007

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