Active NPI
Anita M Waller, PA-C
- Physician Assistant
- Centennial, CO
National Provider Identifier
1558414482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1661
- Practice address
- 6465 Greenwood Plaza Blvd Ste 300
Centennial, CO 80111-7101 - Phone
- (303) 267-3596
- NPI assigned
- Jan 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1661 | CO | Primary |
Addresses
Primary practice location
6465 Greenwood Plaza Blvd Ste 300
Centennial, CO 80111-7101
Mailing address
2315 Hooker St
Denver, CO 80211-4530
Phone (303) 433-4547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1661 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558414482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2315 HOOKER ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802114530",
"telephone_number": "303-433-4547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6465 GREENWOOD PLAZA BLVD STE 300",
"city": "CENTENNIAL",
"state": "CO",
"postal_code": "801117101",
"telephone_number": "303-267-3596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "ANITA",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CO",
"license": "1661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centennial, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.