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Individual provider Active NPI

Bernadette Emily Walters, DNP, AGCNS-BC, APRN

  • Gerontology Nurse Practitioner
  • Las Vegas, NM
National Provider Identifier
1760193544
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
76290 Issued in NM
Practice address
1235 8TH St
Las Vegas, NM 87701-4219
Phone
(505) 425-6788
NPI assigned
Dec 12, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Enterostomal Therapy Registered Nurse 163WE0900X 88504 NM
Wound Care Registered Nurse 163WW0000X 88504 NM
Ostomy Care Registered Nurse 163WX1500X 88504 NM
Gerontology Nurse Practitioner 363LG0600X 76290 NM Primary

Addresses

Primary practice location

1235 8TH St
Las Vegas, NM 87701-4219

Mailing address

205 County Road A2
Sapello, NM 87745-5203
Phone (817) 680-6598

Other practice location 1

205 County Road A2
Sapello, NM 87745-5203
Phone (817) 680-6598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240301001345 NM Practitioner - Nurse Practitioner 0345685236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
El Centro Family HealthGroup PAC ID 9830080688, 31 clinicians

Practice addresses (Care Compare)

1235 8TH St
Las Vegas, NM 87701-4219
Phone (505) 425-6788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
88504NMMDWound Care Registered Nurse
76290NMMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
El Centro Family Health CurrentSince Mar 4, 2024 Accepting new patients
El Centro Family Health Past Accepting new patients

Locations

111 N Railroad Ave
Espanola, NM 87532
Phone (505) 753-7218

1235 8th St
Las Vegas, NM 87701
Phone (505) 425-6751

Organizations & group practices 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1760193544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 COUNTY ROAD A2",
            "city": "SAPELLO",
            "state": "NM",
            "postal_code": "877455203",
            "telephone_number": "817-680-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 8TH ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014219",
            "telephone_number": "505-425-6788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 County Road A2",
            "address_purpose": "LOCATION",
            "city": "Sapello",
            "state": "NM",
            "postal_code": "877455203",
            "country_code": "US",
            "telephone_number": "817-680-6598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "BERNADETTE",
        "middle_name": "EMILY",
        "credential": "DNP, AGCNS-BC, APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-12",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0900X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Enterostomal Therapy",
            "state": "NM",
            "license": "88504",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "NM",
            "license": "88504",
            "primary": false
        },
        {
            "code": "163WX1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ostomy Care",
            "state": "NM",
            "license": "88504",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NM",
            "license": "76290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

Sources for this page

Verify at the official NPI Registry.