Kevin Alan Wall, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

344995 Issued in NY

Practice address

200 Front St Ste C
Vestal, NY 13850-1559

Phone

(607) 239-5694

NPI assigned

Sep 3, 2019

Last updated

Sep 3, 2019By the provider in NPPES

Sex

Male

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

Enrolled in NY

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

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.

• Medical Services of Syracuse

  • Neurology Physician
  • Syracuse, NY
  • NPI 1184050973
  Medicare reassignment

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

{
    "created_epoch": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1386292357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 STATE ROUTE 41",
            "city": "CINCINNATUS",
            "state": "NY",
            "postal_code": "130402215",
            "telephone_number": "607-345-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FRONT ST STE C",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501559",
            "telephone_number": "607-239-5694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "KEVIN",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-03",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "344995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VRNC LLC (Vestal Rehabilitation & Nursing Center)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1835)
• Wal-Mart Stores East, LP. (Walmart pharmacy 10-3164)
• Jamie Leigh Walck
• Walgreen Co (Rite Aid #10799)
• Kelsey Elaine Wallach, DPT
• Jessica Walter
• Mo Walts
• Danielle Marie Ward, DPT.
• Jennifer Wasileski, OTR/L

• Family Nurse Practitioner in Vestal, NY
• Providers in Vestal, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.