Phyllis Annette Walters

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

SS756 Issued in FL

Practice address

9220 Bonita Beach Rd SE Ste 222
Bonita Springs, FL 34135-4235

Phone

(239) 404-9396

NPI assigned

Nov 19, 2019

Last updated

Nov 19, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Phyllis Walters, PH.D.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bonita Springs, FL
  • NPI 1679161491
  NPD

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1326684044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16128 PARQUE LN",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341102816",
            "telephone_number": "239-404-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 BONITA BEACH RD SE STE 222",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354235",
            "telephone_number": "239-404-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "PHYLLIS",
        "middle_name": "ANNETTE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "SS756",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #07851)
• Walgreens
• C.M. Wallace, DDS
• Ryan James Wallace, PT, DPT, OCS, MTC
• Caroline Anne Walters, MA CCC SLP
• Scott Walters, DC
• Fang Wang
• Aref Wappi, M.D.
• Brittney Leigh Warren, D.C.
• Tammy Webb, OT/L

• School Psychologist in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• School Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; 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.