Kevin John Walters, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703079623 Issued in MI

Practice address

3097 Prairie St SW
Grandville, MI 49418-2000

Phone

(616) 531-9973

NPI assigned

Feb 6, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Treece Home Care Inc

  • Home Health Agency
  • Grandville, MI
  • NPI 1649257734
  NPD (past)

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1124650262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3097 PRAIRIE ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182000",
            "telephone_number": "616-531-9973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3097 PRAIRIE ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182000",
            "telephone_number": "616-531-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MI",
            "license": "1649257734",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703079623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Darcy Sandra Walsh
• Kailey Anne Walter
• Kendra Gail Walters, MSPT
• Raymond Wan, M.AC., ADS., LMT.,
• Reilley Nichole Warner, LLMSW
• Taylor Warren
• Mary Katherine Warwick, RN
• Craig Joseph Washington

• Licensed Practical Nurse in Grandville, MI
• Providers in Grandville, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; 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.