Kimberly Theresa McClintock-Walla, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

311577 Issued in NY

Practice address

67 S Main St
Pearl River, NY 10965-2444

Phone

(845) 368-0800

Fax

(845) 368-0810

NPI assigned

Oct 16, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Askenas Chiropractic PC

  • Chiropractor
  • Pearl River, NY
  • NPI 1437167335
  NPD
• Gramercy Medical Pain Management P.a.

  • Specialist
  • Pearl River, NY
  • NPI 1407018633
  NPD

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1750163705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 S MAIN ST",
            "city": "PEARL RIVER",
            "state": "NY",
            "postal_code": "109652444",
            "telephone_number": "845-368-0800",
            "fax_number": "845-368-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 S MAIN ST",
            "city": "PEARL RIVER",
            "state": "NY",
            "postal_code": "109652444",
            "telephone_number": "845-368-0800",
            "fax_number": "845-368-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLINTOCK-WALLA",
        "first_name": "KIMBERLY",
        "middle_name": "THERESA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NY",
            "license": "311577",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "311577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James McCabe
• Kayla Genevieve McCabe
• Susan Sobol McCadden, PT, RN
• Kim Ilene McCarthy
• Elise McCarvill, PT
• Karen McGee
• Theresa McGeever, PT
• Nicole J McIntyre, RDN
• Deirdre McKiernan
• Agnes Josephine McMahon, LPN

• Adult Health Nurse Practitioner in Pearl River, NY
• Providers in Pearl River, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.