Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Walter Thomas Wiswell

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1215469382

Walter Thomas Wiswell is an Emergency Medicine in Jacksonville, Florida. Graduated from Creighton University School of Medicine in 2017, 9 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment.

Years since qualifying
9
Trained at
Creighton University School of Medicine
In the registry since
2017
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Practice location Address checks out

1818 Valencia Dr
Jacksonville, FL 32207-2533
Phone: (904) 434-6281
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1215469382
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 29, 2017
Last updated in NPPESDecember 21, 2021
Mailing address1818 Valencia Dr, Jacksonville, FL 32207-2533

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolCREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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