Kimberly Michelle Waller, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043120655 Issued in IL

Practice address

4707 N Malden St
Apt 303
Chicago, IL 60640-6917

Phone

(312) 975-3312

NPI assigned

Jul 29, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Kimberly Michelle Waller Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1407298698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 N MALDEN ST",
            "address_2": "APT 303",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606406917",
            "telephone_number": "312-975-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 N MALDEN ST",
            "address_2": "APT 303",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606406917",
            "telephone_number": "312-975-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELLE",
        "name_prefix": "Miss",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-29",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043120655",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "128873",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WALLER",
            "middle_name": "MICHELLE",
            "prefix": "MISS",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Yuliya Wallace, PSY.D.
• Chelsea Lynn Wallaert, OTD OTR/L
• Sarah E Wallens, M.A.
• Adrian Waller
• Annika May Waller
• Robert Scott Waller, PSYD
• Sierra Waller
• Thomas Waller
• William Nathan Waller, CCC-SLP
• Derrick D Wallery, D.C.

• Licensed Practical Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.