Individual provider Active NPI

Lee Richmond Walker, PH.D.

  • Psychologist
  • Jacksonville, NC
National Provider Identifier
1487723383
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
725 Issued in NC
Practice address
200 Tarpon TRL
Jacksonville, NC 28546-5287
Phone
(910) 938-1114
NPI assigned
Nov 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 725 NC Primary

Addresses

Primary practice location

200 Tarpon TRL
Jacksonville, NC 28546-5287

Mailing address

145 Executive Circle
Cary, NC 27511
Phone (919) 467-5639

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080714000079 NC Practitioner - Clinical Psychologist 8921170606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Carolina Neuropsychiatric Center PAGroup PAC ID 5890794689, 28 clinicians

Practice addresses (Care Compare)

200 Tarpon TRL
Jacksonville, NC 28546-5287
Phone (910) 938-1114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Carolina Neuropsychiatric Center, PA Psychologist CurrentSince Jun 1, 2008 Accepting new patients

Locations

200 Tarpon Trl
Jacksonville, NC 28546
Phone 9109381114139

302 Penny Ln
Morehead City, NC 28557
Phone (252) 726-8016

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1487723383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 EXECUTIVE CIRCLE",
            "city": "CARY",
            "state": "NC",
            "postal_code": "27511",
            "telephone_number": "919-467-5639",
            "fax_number": "919-467-6871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "LEE",
        "middle_name": "RICHMOND",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

Verify at the official NPI Registry.