Kenna Miranda Walters, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

4526 Issued in AL

Practice address

1672 Columbia Hwy
Dothan, AL 36303-5434

Phone

(334) 712-6400

NPI assigned

Oct 4, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectracare Health Systems IncGroup PAC ID 3779509765, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/spectracare/r4/

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.

• Spectracare Health Systems, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dothan, AL
  • NPI 1215990734
  Medicare reassignment Care Compare group NPD
• Spectracare Integrated Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dothan, AL
  • NPI 1205385176
  NPD

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1689346934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 COUNTY ROAD 610",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363305232",
            "telephone_number": "334-447-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1672 COLUMBIA HWY",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363035434",
            "telephone_number": "334-712-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "KENNA",
        "middle_name": "MIRANDA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AL",
            "license": "4526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Robert Waller
• Walmart
• Steven J Walter, PA-C
• Chase Walters, D.C.
• Kara Walters, PHARMD
• Kimroy Walters
• Latoya Walton-Torrence, MD
• Fady S Wanna, M.D.
• Alicia Ward, MD
• Katie Ward

• Counselor in Dothan, AL
• Providers in Dothan, AL by specialty
• Counselor in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.