Jennifer Nicole Walley, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R864418 Issued in MS

Practice address

73 Long Street
Millry, AL 36558-4564

Phone

(251) 846-3233

Fax

(251) 846-3224

NPI assigned

Feb 17, 2010

Last updated

Jan 31, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS, AL2 enrollments

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 2

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Washington County Healthcare Authority, Inc

  dba Millry Family Care

  • Rural Health Clinic/Center
  • Millry, AL
  • NPI 1316223027
  Medicare reassignment
• USA Health Community Providers LLC

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1801571823
  NPD (past)

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1720300734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 465",
            "city": "MILLRY",
            "state": "AL",
            "postal_code": "365580465",
            "telephone_number": "251-846-3233",
            "fax_number": "251-846-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 LONG STREET",
            "city": "MILLRY",
            "state": "AL",
            "postal_code": "365584564",
            "telephone_number": "251-846-3233",
            "fax_number": "251-846-3224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "951 Matthew Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "MS",
            "postal_code": "393672566",
            "country_code": "US",
            "telephone_number": "601-735-2401",
            "fax_number": "601-735-5205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLEY",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-17",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R864418",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-092094",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05485262",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• I Care Home Health LLC
• McConaghy Drug Store Inc (Millry Drugs)
• Jennifer L McNease, CRNP
• Millry Drugs, LLC
• Gregory R Myrick, M.D.
• Washington County Healthcare Authority, Inc (Millry Family Care)

• Family Nurse Practitioner in Millry, AL
• Providers in Millry, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.