Provider Demographics
NPI:1285485698
Name:YOUR WAY PEDIATRICS
Entity type:Organization
Organization Name:YOUR WAY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALKO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:313-629-1552
Mailing Address - Street 1:360 TOWN PLAZA AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5175
Mailing Address - Country:US
Mailing Address - Phone:904-419-9086
Mailing Address - Fax:864-448-1482
Practice Address - Street 1:360 TOWN PLAZA AVE STE 330
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5175
Practice Address - Country:US
Practice Address - Phone:904-419-9086
Practice Address - Fax:864-448-1482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR WAY PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-01
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health