Priscilla Walters

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

AL12519 Issued in FL

Practice address

4901 Jefferson St
Hollywood, FL 33021-7627

Phone

(954) 482-3360

Fax

(954) 894-1188

NPI assigned

Jan 21, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Evelyn's Place Inc

  • Assisted Living Facility
  • Hollywood, FL
  • NPI 1457040875
  NPD Authorized official

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

{
    "created_epoch": "1484956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484956800000",
    "number": "1629515226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 JEFFERSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330217627",
            "telephone_number": "954-482-3360",
            "fax_number": "954-894-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 JEFFERSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330217627",
            "telephone_number": "954-482-3360",
            "fax_number": "954-894-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "PRISCILLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-21",
        "last_updated": "2017-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "AL12519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "W436671717290",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walkie Talkie Therapy Group, Inc
• Wallace Physical Therapy LLC (ResolveRx)
• Jocelyn Diane Wallace, PT, DPT
• Stephanie Rutledge Wallace, RPH
• Marlene Wallen, ARNP
• Wilson Christopher Walters, COTA
• Melissa Wandique
• Annie P Wang, D.O.
• Bin Wang
• Yungping Wang, D.O.

• Preferred Provider Organization in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2017; 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.