Sandra D Waller, FNP, MSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APN0000005098 Issued in TN

Practice address

2861 Broad Ave
Memphis, TN 38112-2903

Phone

(901) 260-8500

Fax

(901) 325-6469

NPI assigned

May 10, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338940800000",
    "number": "1043260441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 CENTRAL AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381045905",
            "telephone_number": "901-260-8551",
            "fax_number": "901-260-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 BROAD AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381122903",
            "telephone_number": "901-260-8500",
            "fax_number": "901-325-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SANDRA",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "FNP, MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2012-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN0000005098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3346145",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terri Wallace, FNP
• William S Wallace, FNP
• Gwendolyn Felicia Waller-Moore, FNP
• Benjamin R Waller III, MD
• Lindsey Waller
• Yolanda McCain Waller, NP
• Angela Marie Wallick, M.S., R.D.N, L.D.N.
• Callie Ellen Walls, MD
• Carrie P. Walls, PA
• Dana Doriane Walls, B.S.W

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; 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.