Phaedra Lynn Walker, APRN, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9319140 Issued in FL

Practice address

4152 W Blue Heron Blvd Ste 123
Riviera Beach, FL 33404-4859

Phone

(440) 844-7699

NPI assigned

Nov 17, 2014

Last updated

Dec 14, 2020By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1417353566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9047 ALEXANDRA CIR",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334146439",
            "telephone_number": "561-223-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 W BLUE HERON BLVD STE 123",
            "city": "RIVIERA BEACH",
            "state": "FL",
            "postal_code": "334044859",
            "telephone_number": "440-844-7699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2724 N Australian Ave",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334074501",
            "country_code": "US",
            "telephone_number": "561-223-2735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "PHAEDRA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "APRN, DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-17",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9319140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #04528)
• Walgreen Co (Walgreens #3455)
• Ashley N Walker
• Kelly Ann Walker, MSW
• Monica Walker, M.D.
• Tamara L Walker, FNP
• Courtnee Wallace
• Stephanie Wallace, MSW
• Theresa Wallace, OWNER
• Andrew Wallick, MSW

• Family Nurse Practitioner in Riviera Beach, FL
• Providers in Riviera Beach, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.