Ethan Kyle Waltz, LMSW, LMT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

014172 Issued in TN

Practice address

282 Village Lake Cir
Smyrna, TN 37167-4317

Phone

(615) 613-1562

NPI assigned

May 24, 2024

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Dialysis Associates, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Centerville, TN
  • NPI 1053895425
  NPD (past)
• Dialysis Associates, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Smyrna, TN
  • NPI 1538271358
  NPD (past)

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

{
    "created_epoch": "1716508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1730928086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 VILLAGE LAKE CIR",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371674317",
            "telephone_number": "615-613-1562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 VILLAGE LAKE CIR",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "371674317",
            "telephone_number": "615-613-1562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10519 Cedar Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "TN",
            "postal_code": "371676139",
            "country_code": "US",
            "telephone_number": "615-220-1739",
            "fax_number": "615-220-1744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTZ",
        "first_name": "ETHAN",
        "middle_name": "KYLE",
        "credential": "LMSW, LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-24",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "014172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerronica Walker
• Kenesha Walker
• Natosha Walker
• Emily Gea Waller, APN
• Jordan Walsh, DPT
• John Elliott Ward, PH.D.
• Kiara Ward
• Regginald Ward
• Elise F. Waring-Vincent, LCSW
• Warise Family Dentistry PC

• Social Worker in Smyrna, TN
• Providers in Smyrna, TN by specialty
• Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; 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.