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JESSICA WALTHALL PPCNP-BC
NPI 1104316454
Nurse Practitioner - Pediatrics in New York, NY

Active since May 12, 2018
2637 BROADWAY, NEW YORK, NY 10025(917) 921-6219 Get Directions Write a Review

NPPES record last updated: January 18, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jan 18, 2022, Sep 14, 2018, Jul 17, 2018 and 1 more (4 updates tracked since 2018).

About Jessica Walthall Ppcnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA WALTHALL PPCNP-BC (NPI 1104316454) is an individual pediatrics provider in New York, New York, licensed in New York (382872) and active in the NPI registry since May 2018.

NPPES Registry Identity

NPI1104316454
Entity TypeIndividualFemale
Primary Taxonomy363LP0200X
Provider Legal NameJESSICA WALTHALLCredential: PPCNP-BC
Location Address2637 BROADWAYNew York, NY 10025-5022
Mailing Address2637 BroadwayNew York, NY 10025-5022 · (917) 921-6219
Phone(917) 921-6219
Sole ProprietorNo
Enumeration DateMay 12, 2018
Last NPPES UpdateJanuary 18, 20224 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2022
✔ NPI 1104316454 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in NY · 382872
Also ListedRegistered NurseTaxonomy 163W00000X · License 137013 (CT), 727527 (NY)
2637 BROADWAY, New York, NY 10025
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Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MANHATTAN VALLEY PEDIATRICS
Pediatrics
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 575-0133
DR. KELLY LAU
Pediatrics
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 921-6219
REBECCA CORBIN CPNP-PC
Nurse Practitioner (Pediatrics)
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 921-6219
JESSICA J GRANT MD
Pediatrics
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 921-6219
DR. PRANTIK SAHA M.D
Pediatrics
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 921-6219
ALLISON EMILY GATI M.D.
Pediatrics
2637 BROADWAY
NEW YORK, NY 10025
New York County (917) 921-6219

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Walthall's NPI number?

The NPI number for Jessica Walthall is 1104316454. It was assigned to this individual provider in the NPPES registry on May 12, 2018.

Where is Jessica Walthall located?

Jessica Walthall practices at 2637 Broadway, New York, NY 10025. The listed phone number is (917) 921-6219.

What is Jessica Walthall's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

When was this NPI record last updated?

The NPPES record for Jessica Walthall was last updated on January 18, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.