Kellie Faughander Wall, RD, CNSC, CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1058216 Issued in NY

Practice address

750 E Adams St
Syracuse, NY 13210-2306

Phone

(240) 490-1346

NPI assigned

Apr 22, 2019

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

State licenses

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1053974337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9105 ASHLEY LANDING DRIVE",
            "city": "CLAY",
            "state": "NY",
            "postal_code": "13041",
            "telephone_number": "240-490-1346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "240-490-1346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "KELLIE",
        "middle_name": "FAUGHANDER",
        "name_prefix": "Mrs.",
        "credential": "RD, CNSC, CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NY",
            "license": "1058216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela G Walker, LMT
• Peter James Walker, PA-C
• Precious C Walker, LMT
• Stephanie Helen Walker, M.S.-CCC-SLP
• Tracy H Walker, FNP-C
• Stacey B Wall, N.P.
• Alyssa Marie Wallace, LMHC
• Danielle N Wallace, RPH
• Erin Wallace
• Kyrsten Wallace, MD

• Registered Dietitian in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.