Active NPI
Kathy Wall
- Pharmacist
- Mexico, MO
National Provider Identifier
1306364708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 040528
- Practice address
- 340 Kelley Pkwy Ste D
Mexico, MO 65265-3811 - Phone
- (573) 567-7077
- NPI assigned
- Sep 6, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 040528 | MO | Primary |
Addresses
Primary practice location
340 Kelley Pkwy Ste D
Mexico, MO 65265-3811
Mailing address
340 Kelley Pkwy Ste D
Mexico, MO 65265-3811
Phone (573) 567-7077
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 040528 | Other | MO | PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Justbren Inc | Past | Accepting new patients |
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.
-
- Community/Retail Pharmacy
- Mexico, MO
- NPI 1285181081
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1306364708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 KELLEY PKWY STE D",
"city": "MEXICO",
"state": "MO",
"postal_code": "652653811",
"telephone_number": "573-567-7077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 KELLEY PKWY STE D",
"city": "MEXICO",
"state": "MO",
"postal_code": "652653811",
"telephone_number": "573-567-7077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "KATHY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "040528",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "040528",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mexico, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.