Tracey Ann Waller

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

710254 Issued in NY

Practice address

1003 Park St
Ogdensburg, NY 13669-3911

Phone

(518) 651-2302

Fax

(518) 713-9330

NPI assigned

Jan 16, 2025

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)

Not enrolled

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.

• Citizen Advocates, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Malone, NY
  • NPI 1780619064
  NPD

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

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1346051539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 COUNTY ROUTE 51 BLDG 1",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129534502",
            "telephone_number": "518-651-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 PARK ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136693911",
            "telephone_number": "518-651-2302",
            "fax_number": "518-713-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "TRACEY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "710254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP
• Kate-Lyn Waldrif
• Walgreen Co
• Erci Walker
• Ma Jocelyn Walker, PT
• Jeremy M. Warchol, PT
• Jeffery Ward
• Kaitlin Ward
• Kil Y. Ward
• Keith Warren

• Registered Nurse in Ogdensburg, NY
• Providers in Ogdensburg, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.