Carly Waller

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

18600 Wedge Pkwy
Reno, NV 89511-3036

Phone

(775) 283-8461

NPI assigned

May 22, 2023

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 OR

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

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medford Ear Nose and Throat Clinic PC

  dba Oregon Ear Nose and Throat Center

  • Otolaryngology Physician
  • Medford, OR
  • NPI 1669490546
  Medicare reassignment NPD
• Providence Health & Services - Oregon

  dba Providence Medford Medical Center

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1689755670
  NPD (past)

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1821780735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 TERRACE ST",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975202834",
            "telephone_number": "775-283-8461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18600 WEDGE PKWY",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113036",
            "telephone_number": "775-283-8461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "CARLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Alexander Wallace III, PT
• Kelsey Wallace
• Scott Michael Wallace, M.D.
• Trevor Wallace
• Trudy Wallace, RD
• Kailee Waller, RN
• Kelly Waller
• Victoria Wallington, CPHT
• David Harisson Wallum, DPT
• Walmart Inc. (Walmart Pharmacy 10-2189)

• Student in an Organized Health Care Education/Training Program in Reno, NV
• Providers in Reno, NV by specialty
• Student in an Organized Health Care Education/Training Program in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.