Kimberly Waller-Johnson, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

213192 Issued in AR

Practice address

4000 Richards Rd Ste 4000
North Little Rock, AR 72117-2650

Phone

(501) 758-5133

Fax

(501) 758-5173

NPI assigned

Sep 25, 2020

Last updated

Nov 11, 2022By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  AR

  Medicare reassignment NPD

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1528675386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 RICHARDS RD STE A",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172939",
            "telephone_number": "501-758-5133",
            "fax_number": "501-758-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 RICHARDS RD STE 4000",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172650",
            "telephone_number": "501-758-5133",
            "fax_number": "501-758-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER-JOHNSON",
        "first_name": "KIMBERLY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "213192",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R082821",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquis D Walker, LCSW
• Shelton Walker, LPC
• Sommer Shurae Walker, PA-C
• Chris D Wall, M.D.
• Ama Gean Wallace, RD
• Jennifer Nipps Wallgren, RNFA
• Claire Wallin
• Walmart Inc. (Walmart Pharmacy 10-1105)
• Serifatu Tamara Walton-Buford, LMFT-A
• Sara Michelle Walton, CASE MANAGER

• Acute Care Nurse Practitioner in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Acute Care Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.