Kongkeo Thiky Walther, ANP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

2015040094 Issued in MO

Practice address

12774 Boenker LN
Bridgeton, MO 63044-2436

Phone

(314) 291-7997

Fax

(314) 739-1471

NPI assigned

Dec 3, 2015

Last updated

Dec 21, 2023By 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

Other identifiers 1

Other names 1

• Kongkeo Thiky Vorachack Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Infectious Disease Services LLCGroup PAC ID 0446216063, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
• Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
• Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Northwest Infectious Disease Services LLC

  • Infectious Disease Physician
  • Bridgeton, MO
  • NPI 1306891551
  Medicare reassignment Care Compare group NPD
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Barnes Jewish St Peters Hospital Inc

  dba Barnes-Jewish St Peters Hospital

  • General Acute Care Hospital
  • Saint Peters, MO
  • NPI 1144238908
  Care Compare affiliation
• Christian Hospital Northeast- Northwest

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1639186760
  Care Compare affiliation
• Christian Hospital Northeast-Northwest

  dba Christian Hospital

  • Ambulance
  • Saint Louis, MO
  • NPI 1073769329

  Hospital

  Care Compare affiliation
• Missouri Baptist Medical Center

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1487663506
  Care Compare affiliation

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

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1528433430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776874",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776874",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12774 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442436",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4921 Parkview Pl",
            "address_2": "Div Surg Urology, Ste 11C",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101032",
            "country_code": "US",
            "telephone_number": "314-362-8200",
            "fax_number": "314-454-5244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTHER",
        "first_name": "KONGKEO",
        "middle_name": "THIKY",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-03",
        "last_updated": "2023-12-21",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2015040094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420030952",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4921 Parkview Pl",
            "address_2": "Div Surg Urology, Ste 11C",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KONGKEO",
            "last_name": "VORACHACK",
            "middle_name": "THIKY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walgreen Co (Walgreens #02501)
• Walgreens Pharmacy
• Valerie O Walker, M.D.
• Christopher Waller
• Alyssa Walters, MOT, OTR/L
• William Wang, M.D.
• Victoria Wannemuehler, MS, RDN, LD
• Waqar Ulislam Mirza MD
• Jeniffer Ane Washington
• Keisha L Waters

• Acute Care Nurse Practitioner in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Acute Care Nurse Practitioner in Missouri

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