Teresa Cantrell Walters, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP032543 Issued in PA

Practice address

20 Pinegrove Blvd
Russell, PA 16345-1118

Phone

(205) 452-9789

NPI assigned

Jul 13, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, NY2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: teresa.walters.1@10044.direct.athenahealth.com
• FHIR API: https://fhir-usa.unify.chbase.com/org/corrymh-73713d5f
• FHIR API: https://api.platform.athenahealth.com/10044/brand/1/csg/1/fhir/r4

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.

• Corry Memorial Hospital Association

  • Rural Health Clinic/Center
  • Corry, PA
  • NPI 1124406376
  Medicare reassignment NPD
• Corry Memorial Hospital Association

  • Rural Health Clinic/Center
  • Union City, PA
  • NPI 1255967956

  Family

  Medicare reassignment NPD
• Corry Memorial Hospital Association

  • Rural Health Clinic/Center
  • Clymer, NY
  • NPI 1255922043

  Family

  Medicare reassignment NPD
• Corry Memorial Hospital Association

  • Critical Access Hospital
  • Corry, PA
  • NPI 1255788014
  NPD (past)

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

{
    "created_epoch": "1720828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1649017807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3132 SYDENTON DR",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352445627",
            "telephone_number": "205-452-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PINEGROVE BLVD",
            "city": "RUSSELL",
            "state": "PA",
            "postal_code": "163451118",
            "telephone_number": "205-452-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "TERESA",
        "middle_name": "CANTRELL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-13",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-168597",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN800330",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "975616",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-168597",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "356260",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP032543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dawn Venman, RD, LDN, CLC
• Warren County School District

• Family Nurse Practitioner in Russell, PA
• Providers in Russell, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; 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.