Kelly White Wall, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN170495 Issued in GA

Practice address

414 Lugenia Dr
Vidalia, GA 30474-7210

Phone

(912) 537-9355

Fax

(912) 335-4804

NPI assigned

Oct 3, 2018

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)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1194290338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1416",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304751416",
            "telephone_number": "706-833-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 LUGENIA DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304747210",
            "telephone_number": "912-537-9355",
            "fax_number": "912-335-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "KELLY",
        "middle_name": "WHITE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-03",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN170495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Lyndsay M Waldhour, RD, LD
• Walgreen Co
• Walker Pharmacy and Gifts, Inc.
• Elizabeth Denise Wallace
• Leah M Waller, PA
• Deborah Ward, L.P.C.
• Carl Anthony Wardlaw, LPC
• Kimberly Rae Warren, MSN, APRN, AGPCNP-BC

• Family Nurse Practitioner in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.