Katie Waller

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

227616 Issued in AR

Practice address

3111 S 70TH St
Fort Smith, AR 72903-5017

Phone

(903) 749-1755

NPI assigned

Feb 7, 2024

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 AR

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Western Arkansas Counseling & Guidance Center, Inc

  • Community/Behavioral Health Agency
  • Fort Smith, AR
  • NPI 1326040692
  Medicare reassignment NPD
• The Guidance Center - Whole Health

  • Family Medicine Physician
  • Fort Smith, AR
  • NPI 1730787037

  Psychiatric/Mental Health

  NPD
• Western Arkansas Counseling & Guidance Center

  • Community/Behavioral Health Agency
  • Fort Smith, AR
  • NPI 1447425665
  NPD

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1043074396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 RED OAK ST",
            "city": "ELKINS",
            "state": "AR",
            "postal_code": "727277201",
            "telephone_number": "903-749-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 S 70TH ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729035017",
            "telephone_number": "903-749-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KATIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "227616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Ray Walker
• Bridget Marie Wall
• Wallace Hays Family Chiropractic Clinic, PA
• Alana Wallace, QBHP
• Kenneth K Wallace, M.D.
• Toni Wallis, DC
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.

• Psychiatric/Mental Health Nurse Practitioner in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.