Kellie Ann Wahl, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704291998 Issued in MI

Practice address

1108 Valentine Cir
Chattanooga, TN 37405-2866

Phone

(231) 920-5625

NPI assigned

Oct 2, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Health Care PCGroup PAC ID 1254677719, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kellie.herringa.1@21307.direct.athenahealth.com

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.

• Samaritan Health Care, PC

  • Family Medicine Physician
  • Greenville, MI
  • NPI 1598234056
  Medicare reassignment Care Compare group NPD
• Apogee Medical Group, Michigan, PC

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1053655134

  MI

  Medicare reassignment NPD
• Covenant Medical Center, Inc.

  dba Covenant HealthCare

  • Emergency Medicine Physician
  • Saginaw, MI
  • NPI 1972590412
  Medicare reassignment NPD
• Hometown Family Medical Centers, PLLC

  • Family Medicine Physician
  • Newaygo, MI
  • NPI 1245035021
  Medicare reassignment NPD
• Bear River Primary Care

  dba MI Better Health and Wellness

  • Family Medicine Physician
  • Gaylord, MI
  • NPI 1609427541
  Medicare reassignment
• Covenant Medical Center, Inc

  • Family Medicine Physician
  • Saginaw, MI
  • NPI 1619412376
  NPD
• Hometown Family Medical Centers, PLLC

  • Rural Health Clinic/Center
  • Newaygo, MI
  • NPI 1114720554
  NPD
• Samaritan Health Care PC

  • Rural Health Clinic/Center
  • Greenville, MI
  • NPI 1336865252
  NPD
• Walloon Lake Recovery Lodge, LLC

  dba Bear River Health

  • Substance Abuse Rehabilitation Facility
  • Boyne Falls, MI
  • NPI 1750791505
  NPD

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

{
    "created_epoch": "1443744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1013387000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2329 CENTER ST",
            "city": "BOYNE FALLS",
            "state": "MI",
            "postal_code": "497139268",
            "telephone_number": "231-535-2822",
            "fax_number": "833-992-2439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 VALENTINE CIR",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374052866",
            "telephone_number": "231-920-5625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "KELLIE",
        "middle_name": "ANN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-02",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704291998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Wagner, DO
• Marcus M Wagner, M.D.
• Randi Lynn Wagner, PA-C
• Stacey Ketry Wagner
• Wagstaff Counseling Services LLC
• Nancy Graves Wahler, LCSW
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5251)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3619)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3660)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3659)

• Nurse Practitioner in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.