Katey Waldon, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

347812 Issued in NY

Practice address

4110 Medical Center Dr
Fayetteville, NY 13066-6613

Phone

(315) 663-0100

NPI assigned

Apr 1, 2016

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

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

Specialty

Nurse Practitioner

Education

State University of Ny Upstate Medical University, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Fazeli and Dr. Broumand LLCGroup PAC ID 0446358063, 11 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Dr. Fazeli & Dr. Broumand LLC

  • Dermatology Physician
  • Fayetteville, NY
  • NPI 1336235639
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1487017901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666613",
            "telephone_number": "315-663-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDON",
        "first_name": "KATEY",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-01",
        "last_updated": "2023-03-15",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "707400",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "347812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Village of Fayetteville
• Vitkus, Scutari & Cardoso Oral Surgery PC
• James M Vlassis, DDS
• Susan Marie Volles, NP
• Elizabeth M. Wade, L.C.S.W.
• Keith Paul Waldron, P.T.
• Walgreen Co (Walgreens #18166)
• Julie M Wallace, PT
• Douglas Walsh, MD
• Hannah Joan Walsh, FNP-C

• Family Nurse Practitioner in Fayetteville, NY
• Providers in Fayetteville, 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 Mar 15, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.