Individual provider Active NPI

Lauren Kay Walter, N.P.

  • Family Nurse Practitioner
  • Fleming Island, FL
National Provider Identifier
1457615684
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11027161 Issued in FL
Practice address
4565 US Highway 17 Ste 106
Fleming Island, FL 32003-4822
Phone
(317) 274-2304
Fax
(317) 274-4554
NPI assigned
Jul 3, 2012
Last updated
May 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 71004001A IN
Family Nurse Practitioner 363LF0000X APRN11027161 FL Primary

Addresses

Primary practice location

4565 US Highway 17 Ste 106
Fleming Island, FL 32003-4822

Mailing address

425 W Colonial Dr Ste 303
Orlando, FL 32804-6863
Phone (904) 745-3618

Other names 1

  • Lauren Kay Montgomery Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230823000995 FL Practitioner - Nurse Practitioner 5092943829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illumia Health LLCGroup PAC ID 7810424306, 33 clinicians

Practice addresses (Care Compare)

8130 Baymeadows Way W
Suite 201a
Jacksonville, FL 32256-7451
Phone (904) 503-9442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71004001AINMDAdult Health Nurse Practitioner
APRN11027161FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-South Home Care Services, LLC CurrentSince Sep 30, 2024 Accepting new patients
Mid-South Home Care Services, LLC Current Accepting new patients
Mid-South Home Care Services, LLC CurrentSince Sep 30, 2024 Accepting new patients
Illumia Health LLC CurrentSince Feb 22, 2025 Accepting new patients
Illumia Health LLC CurrentSince Feb 22, 2025 Accepting new patients

Locations

8130 Baymeadows Way W
Ste 201
Jacksonville, FL 32256
Phone (740) 988-5042

8130 Baymeadows Way W
Ste 201A
Jacksonville, FL 32256
Phone (904) 503-9442

4776 New Broad St
Ste 150
Orlando, FL 32814
Phone (407) 794-8382

950 S Dillard St
Ste A
Winter Garden, FL 34787
Phone (352) 816-2600

655 Brawley School Rd
Ste 200
Mooresville, NC 28117

Interoperability endpoints

  • Direct secure messaging: lauren.walter.1@27472.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1457615684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W COLONIAL DR STE 303",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046863",
            "telephone_number": "904-745-3618",
            "fax_number": "904-722-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 US HIGHWAY 17 STE 106",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034822",
            "telephone_number": "317-274-2304",
            "fax_number": "317-274-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "LAUREN",
        "middle_name": "KAY",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-03",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71004001A",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11027161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "MONTGOMERY",
            "middle_name": "KAY",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fleming Island, FL

Sources for this page

Verify at the official NPI Registry.