Collaborative Care of Floyd, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024171212 Issued in VA

Legal business name

COLLABORATIVE CARE OF FLOYD, LLC

Practice address

1069 Timberline Rd SE
Copper Hill, VA 24079-2729

Phone

(540) 239-7311

NPI assigned

Jul 14, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jerusalem Walker, FNP-BC

Title

Sole Member

Phone

(540) 239-7311

Specialties & licenses 1

Addresses

Other names 1

• Collaborative Care of Floyd Doing business as

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1043663016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 TIMBERLINE RD SE",
            "city": "COPPER HILL",
            "state": "VA",
            "postal_code": "240792729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 TIMBERLINE RD SE",
            "city": "COPPER HILL",
            "state": "VA",
            "postal_code": "240792729",
            "telephone_number": "540-239-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE CARE OF FLOYD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "JERUSALEM",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "540-239-7311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024171212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collaborative Care of Floyd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Copper Hill, VA
• Providers in Copper Hill, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.