Healthmark of Walton Rural Health Clinic Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

HEALTHMARK OF WALTON RURAL HEALTH CLINIC INC

Practice address

4415 US Highway 331 S
Defuniak Springs, FL 32435-6307

Phone

(850) 951-4640

Fax

(850) 892-7079

NPI assigned

Nov 4, 2005

Organization subpart

Yes

Parent organization

HEALTHMARK OF WALTON INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Shirley Holley

Title

Coo

Phone

(850) 951-4507

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Healthmark Clinic Other name

Part of

Walton Regional Hospita

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Healthmark of Walton Inc.

  • Home Health Agency
  • Defuniak Springs, FL
  • NPI 1578544649

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Nichole Bryant, APRN

  • Family Nurse Practitioner
  • Defuniak Springs, FL
  • NPI 1235719584

  Rural Health

  NPD
• Thomas G Roberts, PA-C

  • Medical Physician Assistant
  • Miramar Beach, FL
  • NPI 1205859857
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1013908201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324356307",
            "telephone_number": "850-951-4640",
            "fax_number": "850-892-7079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324356307",
            "telephone_number": "850-951-4640",
            "fax_number": "850-892-7079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHMARK OF WALTON RURAL HEALTH CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHMARK OF WALTON INC",
        "enumeration_date": "2005-11-04",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "HOLLEY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "SHIRLEY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "850-951-4507",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372384401",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthmark Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Healthmark Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Wendy M Harris, FNP-C
• Arjan Hayer
• Kerrian A Hazley, MD
• Healthmark of Walton Inc
• Healthmark of Walton Inc.
• Healthy Transitions, LLC
• Lauran L Hebert
• Melinda C. Henderson, ARNP, FAAN,
• Lily Rayanne Herndl
• Samantha Hewett, RBT

• Rural Health Clinic/Center in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Rural Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.