Nanette L Waller, LCSW, CCFC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

1760 Issued in SD

Practice address

1011 Honor Heights Dr
Muskogee, OK 74401-1318

Phone

(918) 683-3261

NPI assigned

Jul 26, 2006

Last updated

Apr 17, 2020By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nlwaller22@sbcglibal.net

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.

• Fortis Therapy LLC

  • Community/Behavioral Health Agency
  • Oklahoma City, OK
  • NPI 1962708883
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1508880501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6351 W 22ND ST N",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744011031",
            "telephone_number": "918-360-8275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 HONOR HEIGHTS DR",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744011318",
            "telephone_number": "918-683-3261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6351 W 22nd St N",
            "address_purpose": "LOCATION",
            "city": "Muskogee",
            "state": "OK",
            "postal_code": "744011031",
            "country_code": "US",
            "telephone_number": "918-360-8275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "NANETTE",
        "middle_name": "L",
        "credential": "LCSW, CCFC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "SD",
            "license": "1760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Nlwaller22@sbcglibal.net",
            "affiliation": "N",
            "endpointDescription": "Home",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6351 W 22nd St N",
            "city": "Muskogee",
            "state": "OK",
            "country_code": "US",
            "postal_code": "744011031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derra Walker
• Kaitlyn Walker, DDS
• Margaret Joanna Walker
• Tamala Walker
• Melinda Raylene Wall, MSN, RN
• Tessa Walls
• Elizabeth Walrath, NP-C
• Retonya J Walters
• Sericca Lynn Walters, RD LD
• Robert S Wang, O.D.

• Social Worker in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.