Shelly M Waldern, ARNP FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP30007126 Issued in WA

Practice address

916 Koala Dr
Omak, WA 98841

Phone

(509) 662-8711

NPI assigned

Oct 4, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Bourget Health Services Inc

  dba Pathology Associates Med Laboratories

  • Clinical Medical Laboratory
  • Spokane, WA
  • NPI 1033117338
  NPD (past)
• Public Hospital District 1 of King County

  dba Prescription Pad Pharmacy South

  • Institutional Pharmacy
  • Renton, WA
  • NPI 1679862189
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526428800000",
    "number": "1598850786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 KOALA DR",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-662-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDERN",
        "first_name": "SHELLY",
        "middle_name": "M",
        "credential": "ARNP FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2018-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30007126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598850786",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maricela Vargas
• Jennifer Vazquez
• Abraham Velasco Bustamante, PA
• Blair Noel Velez-Kelsey, MHCP
• Wal-Mart Stores Inc (Vision Center 30-1947)
• Katie Renee Walker, MSW
• Barbara J Wallace, LICSW
• Adam John Wallenta, PA-C
• Walmart Inc. (Walmart Pharmacy 10-1947)
• Washington Em-I Medical Services PC

• Family Nurse Practitioner in Omak, WA
• Providers in Omak, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.