Carly Lynne Waller, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

CNM699 Issued in NC

Practice address

9955 Poplar Tent Rd
Concord, NC 28027-9314

Phone

(704) 316-4828

Fax

(704) 316-4829

NPI assigned

Jun 26, 2018

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1649765389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9955 POPLAR TENT RD",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280279314",
            "telephone_number": "704-316-4828",
            "fax_number": "704-316-4829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1302 Lexington Ave",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "NC",
            "postal_code": "273603419",
            "country_code": "US",
            "telephone_number": "336-475-6139",
            "fax_number": "336-475-3331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14330 Oakhill Park Ln Ste 200",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280783407",
            "country_code": "US",
            "telephone_number": "704-316-4830",
            "fax_number": "704-316-4831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "CARLY",
        "middle_name": "LYNNE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NC",
            "license": "CNM699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWIFERY JOINT COMMITTEE OF THE STATE OF NORTH CAROLINA",
            "identifier": "CNM04927",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwaller669388@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1302 Lexington Ave",
            "city": "Thomasville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "273603419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwaller669388@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "9955 Poplar Tent Rd",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280279314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Randy Lee Wall, LPC, NCC
• Caroline Wallace
• Jakeyla Wallace
• Jennifer Leigh Wallace, PHARM D
• Tamera Waller-Drye
• Laura Elizabeth Waller
• Melissa Waller
• Lacey Beth Walls, D.O.
• Bonnie Leanne Walsh, MSE, RD, LDN
• Charlene M Walsh, PA-C

• Advanced Practice Midwife in Concord, NC
• Providers in Concord, NC by specialty
• Advanced Practice Midwife in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.