Kelli Maureen Wall, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5011726 Issued in NC

Practice address

110 Kildaire Farm Rd
Charlotte, NC 27518-8162

Phone

(919) 235-6575

Fax

(919) 235-6598

NPI assigned

Oct 14, 2015

Last updated

Dec 16, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelli.wallapn.p29@direct.fhn-fqhc.nextgenshare.com

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.

• Wake Specialty Physicians, LLC

  • Surgery Physician
  • Raleigh, NC
  • NPI 1942440375
  Medicare reassignment NPD
• Wake Specialty Physicians LLC

  dba WakeMed Childrens Pediatric Primary Care - Fuquay-Varina Medical Park

  • Pediatrics Physician
  • Fuquay Varina, NC
  • NPI 1578334892
  NPD
• Wake Specialty Physicians LLC

  dba Wakemed Primary Care Kildaire Farm Road

  • Family Medicine Physician
  • Cary, NC
  • NPI 1871052597
  NPD
• Riverside Health System

  • General Practice Physician
  • Kankakee, IL
  • NPI 1417061193
  NPD (past)

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

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1811368905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "919-350-8991",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 KILDAIRE FARM RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "275188162",
            "telephone_number": "919-235-6575",
            "fax_number": "919-235-6598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5918 Illuminate Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276164347",
            "country_code": "US",
            "telephone_number": "815-302-2494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALL",
        "first_name": "KELLI",
        "middle_name": "MAUREEN",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-14",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5011726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Teresa Wall, FNP
• Fallon Victoria Wall
• Felisha M Wall, RN
• George Bryan Wall, DMD
• Kelli Anne Wall
• Mary Angela Wall, SLP
• Michael Wall
• Randolph Carey Wall, PH.D.
• Debbie Ann Wallace-Pratt, LCSWA
• Alysen Janae Wallace, MS, LPCA

• Family Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.