Individual provider Active NPI

Benjamin Isaiah Walker III, ARNP, D.C.

  • Family Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1649391145
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9307392 Issued in FL
Practice address
16171 Rambling Vine Dr E
Tampa, FL 33624-1196
Phone
(813) 961-1712
NPI assigned
Apr 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH6247 FL
Family Nurse Practitioner 363LF0000X 9307392 FL Primary

Addresses

Primary practice location

16171 Rambling Vine Dr E
Tampa, FL 33624-1196

Mailing address

16171 Rambling Vine Dr E
Tampa, FL 33624-1196
Phone (813) 961-1712

Other practice location 1

322 S 6th Ave
Wauchula, FL 33873-3207
Phone (863) 767-1211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20160426001445 MN Order and Referring Only - Nurse Practitioner 3476852401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH6247FLMDChiropractor
9307392FLMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1649391145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16171 RAMBLING VINE DR E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241196",
            "telephone_number": "813-961-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16171 RAMBLING VINE DR E",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241196",
            "telephone_number": "813-961-1712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "322 S 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Wauchula",
            "state": "FL",
            "postal_code": "338733207",
            "country_code": "US",
            "telephone_number": "863-767-1211",
            "fax_number": "863-767-1216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "BENJAMIN",
        "middle_name": "ISAIAH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "ARNP, D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH6247",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9307392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.