Kathlene Sue Waller, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

30233 Issued in CO

Practice address

Hartshorn Health Service
Colorado State University
Fort Collins, CO 80523-8031

Phone

(970) 491-7121

Fax

(970) 491-0226

NPI assigned

Aug 5, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Colorado State University Hartshorn Health Service

  • Registered Nurse
  • Fort Collins, CO
  • NPI 1518187301
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023027778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HARTSHORN HEALTH SERVICE",
            "address_2": "COLORADO STATE UNIVERSITY",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805238031",
            "telephone_number": "970-491-7121",
            "fax_number": "970-491-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HARTSHORN HEALTH SERVICE",
            "address_2": "COLORADO STATE UNIVERSITY",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805238031",
            "telephone_number": "970-491-7121",
            "fax_number": "970-491-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KATHLENE",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CO",
            "license": "30233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Counseling, LLC
• Wallace Counseling, LLC
• Anne Wallace, MD
• Lisa M Wallace, MA, LPC
• Susan Wallace, LPN
• Kristin Wallick, M.D.
• Daniel Wallis, DC
• Jacque Wallis, RN
• Lisa Wallis, BA
• Peter A Wallskog, MD

• Pediatric Adolescent Medicine Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Pediatric Adolescent Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.