Individual provider Active NPI

Reynel B Walden, FNP-C

  • Family Nurse Practitioner
  • Kansas City, MO
National Provider Identifier
1255008686
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2021035406 Issued in MO
Practice address
4330 Wornall Rd Ste 2000
Kansas City, MO 64111-5939
Phone
(816) 931-1883
NPI assigned
Aug 24, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 53-80496-091 KS
Family Nurse Practitioner 363LF0000X 2021035406 MO Primary

Addresses

Primary practice location

4330 Wornall Rd Ste 2000
Kansas City, MO 64111-5939

Mailing address

901 E 104TH St
Mailstop 400S
Kansas City, MO 64131
Phone (816) 931-1883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240501002976 KS Practitioner - Nurse Practitioner 4688014111 Reassigns benefits to 1 organization
I20240501003230 MO Practitioner - Nurse Practitioner 4688014111 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Missouri, Kansas City, School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

12330 Metcalf Ave
Suite 280
Overland Park, KS 66213-1302
Phone (816) 931-1883

4330 Wornall Rd
Suite 2000
Kansas City, MO 64111-5939
Phone (816) 931-1883

Hospital & facility affiliations

  • St Lukes Hospital of Kansas City Hospital, Kansas City, MO, CCN 260138
  • Saint Luke'S East Hospital Hospital, Lees Summit, MO, CCN 260216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2021035406MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc CurrentSince Jun 10, 2024 Accepting new patients

Locations

711 Marshall St
Leavenworth, KS 66048
Phone (913) 684-1100

12330 Metcalf Ave
Ste 280
Overland Park, KS 66213
Phone (913) 491-1000

12330 Metcalf Ave
Ste 500A
Overland Park, KS 66213
Phone (913) 323-9000

901 E 104th St
#400S
Kansas City, MO 64131
Phone (816) 502-7117

5844 NW Barry Rd
Ste 110
Kansas City, MO 64154
Phone (816) 880-6100

4330 Wornall Rd
Ste 2000
Kansas City, MO 64111

20 NE Saint Lukes Blvd
Ste 240
Lees Summit, MO 64086

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Organizations & group practices 1

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1255008686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E 104TH ST",
            "address_2": "MAILSTOP 400S",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "64131",
            "telephone_number": "816-931-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 WORNALL RD STE 2000",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641115939",
            "telephone_number": "816-931-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "REYNEL",
        "middle_name": "B",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-80496-091",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2021035406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.