Active NPI
Kelly Nicole Walters, CPNP
- Nurse Practitioner
- Bethel, OH
National Provider Identifier
1407836828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN281265 NP06528
- Practice address
- 210 N Union St
Bethel, OH 45106-1124 - Phone
- (513) 734-9050
- Fax
- (513) 734-9051
- NPI assigned
- Jan 20, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN281265 NP06528 | OH | Primary |
Addresses
Primary practice location
210 N Union St
Bethel, OH 45106-1124
Mailing address
5400 Dupont Cir
Suite a
Milford, OH 45150-2793
Phone (513) 576-7700
Other practice location 1
150 Health Partners Circle
Mt. Orab, OH 45154-1101
Phone (937) 444-2514
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2561624 | Medicaid | OH | |
| 2565399 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN281265 NP06528 | OH | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1407836828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5400 DUPONT CIR",
"address_2": "SUITE A",
"city": "MILFORD",
"state": "OH",
"postal_code": "451502793",
"telephone_number": "513-576-7700",
"fax_number": "513-576-1020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 N UNION ST",
"city": "BETHEL",
"state": "OH",
"postal_code": "451061124",
"telephone_number": "513-734-9050",
"fax_number": "513-734-9051"
}
],
"practiceLocations": [
{
"address_1": "150 Health Partners Circle",
"address_purpose": "LOCATION",
"city": "Mt. Orab",
"state": "OH",
"postal_code": "451541101",
"country_code": "US",
"telephone_number": "937-444-2514",
"fax_number": "937-444-4818",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALTERS",
"first_name": "KELLY",
"middle_name": "NICOLE",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "RN281265 NP06528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2561624",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2565399",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.