Kamika Wall

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

24058 Issued in TN

Practice address

7040 Wind Stone Blvd Ste 150
Olive Branch, MS 38654-9090

Phone

(662) 874-5828

Fax

(662) 874-5870

NPI assigned

Mar 14, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Design Your Wellness, LLC

  • Health Service Clinic/Center
  • Olive Branch, MS
  • NPI 1033989330
  NPD Authorized official
• Rejuvenating Health and Wellness, LLC

  dba Rejuvenating Health and Wellness Care Home, LLC

  • Nursing Care Agency
  • Cordova, TN
  • NPI 1548939499
  NPD Authorized official

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

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1285137380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 515",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380880515",
            "telephone_number": "901-484-9099",
            "fax_number": "470-222-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7040 WIND STONE BLVD STE 150",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386549090",
            "telephone_number": "662-874-5828",
            "fax_number": "662-874-5870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8254 Weatherwood Ln",
            "address_purpose": "LOCATION",
            "city": "Cordova",
            "state": "TN",
            "postal_code": "380186344",
            "country_code": "US",
            "telephone_number": "901-352-8350",
            "fax_number": "470-222-2771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1009 Windcross Ct Ste 101",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "TN",
            "postal_code": "370672678",
            "country_code": "US",
            "telephone_number": "901-651-1647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALL",
        "first_name": "KAMIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-14",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "905658",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "24058",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "169468",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TN",
            "license": "24058",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "916499",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP (Vision Center 30-2846)
• Walgreen Co (Walgreens #10517)
• Walgreen Co (Walgreens #07130)
• Jasmine Jeterra Walker
• Loreal Walker, LCSW
• Andrea Wallace, FNP-C
• Rachel Walton
• Richard Edward Warden II, D.C.
• Stacy L Warden, PT
• Washington Group, PLLC

• Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; 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.