Kimberly Kay Waller-Brown, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3587 Issued in WV

Practice address

1609 Maryland Ave
Bluefield, WV 24701-3803

Phone

(304) 327-5506

Fax

(304) 324-8703

NPI assigned

Nov 9, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 16, 2015 through Apr 16, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Conklin & Doersch DDS Inc

  • Dentist
  • Bluefield, WV
  • NPI 1972612588
  NPD (past)
• Thomas L Conklin DDS Inc

  • Dentist
  • Bluefield, WV
  • NPI 1295846053
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1477623007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 MARYLAND AVE",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013803",
            "telephone_number": "304-327-5506",
            "fax_number": "304-327-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 MARYLAND AVE",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247013803",
            "telephone_number": "304-327-5506",
            "fax_number": "304-324-8703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER-BROWN",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "name_prefix": "Miss",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "3587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810000311",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Virginias Dermatology, Inc.
• Robert A Wade, O.D.
• Walgreen Co
• Walgreen Co.
• Chastity Leigh Walker, FNP-BC
• Stephen Ward, M.D.
• Debbie Rose Warrenfeltz
• Shylyn Washington
• Leah Watkins
• Tori Watkins

• General Practice Dentistry in Bluefield, WV
• Providers in Bluefield, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.