Kaylie Dionne Waters, RN, BSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704316107 Issued in MI

Practice address

1445 Sheldon Rd
Ste 300
Grand Haven, MI 49417

Phone

(616) 296-1500

Fax

(616) 296-1502

NPI assigned

Jun 14, 2021

Last updated

Nov 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13864/brand/1/csg/1/fhir/r4
• Direct secure messaging: kwaters30076@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mercy Physician Network

  • Family Medicine Physician
  • Muskegon, MI
  • NPI 1023056744

  Nurse Practitioner

  Medicare reassignment NPD
• Noch Physician Billing Company LLC

  • Family Medicine Physician
  • Grand Haven, MI
  • NPI 1972550580
  Medicare reassignment NPD
• Mercy Physician Network

  dba Fruitport Family Medicine

  • Family Medicine Physician
  • Fruitport, MI
  • NPI 1639502701

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1235707605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776982",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776982",
            "telephone_number": "231-672-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 SHELDON RD",
            "address_2": "STE 300",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "49417",
            "telephone_number": "616-296-1500",
            "fax_number": "616-296-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "KAYLIE",
        "middle_name": "DIONNE",
        "credential": "RN, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-14",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704316107",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704316107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP (Walmart Pharmacy10-5386)
• Wal-Mart Stores East, LP (Vision Center 30-5386)
• Walgreen Co (Walgreens #12345)
• Walgreen Co (Walgreens #03349)
• Logan Walker, DO
• Hailey Catherine Watkins, DC
• Cara Ashni Weber, OT
• Walter E Weber, DDS
• Noah Weigle, DDS
• Jessica Amber Weishaar

• Nurse Practitioner in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.