NPIMap

Individual provider Active NPI

Kathryn Elizabeth Waller, FNP-C

  • Family Nurse Practitioner
  • Tullahoma, TN
National Provider Identifier
1841562907
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16415 Issued in TN
Practice address
1805 N Jackson St Ste 100
Tullahoma, TN 37388-2291
Phone
(931) 455-7767
NPI assigned
Feb 6, 2012
Last updated
Jul 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16415 TN Primary

Addresses

Primary practice location

1805 N Jackson St Ste 100
Tullahoma, TN 37388-2291

Mailing address

3841 Green Hills Village Dr Ste 200
Nashville, TN 37215-2691

Other identifiers 1

IdentifierTypeStateIssuer
1528507MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kathryn.waller.2@5872.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20120511000483 TN Practitioner - Nurse Practitioner 4587827407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1805 N Jackson St
Tullahoma, TN 37388-2290
Phone (931) 461-4521

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Vanderbilt Integrated Providers, LLC CurrentSince Feb 9, 2021 Accepting new patients
Vanderbilt Integrated Providers, LLC Family CurrentSince Feb 9, 2021 Accepting new patients
Community Hospices of America - Tennessee, LLC Past Accepting new patients

Locations

1400 Willow Dr
Manchester, TN 37355
Phone (931) 409-2194

3841 Green Hills Village Dr
Ste 200
Nashville, TN 37215
Phone (615) 322-6842

1805 N Jackson St
Ste 100
Tullahoma, TN 37388
Phone (931) 455-7767

1805 N Jackson St
Ste 11
Tullahoma, TN 37388
Phone (931) 455-9118

Interoperability endpoints

  • Direct secure messaging: kwaller602316@direct.vumc.org

Organizations & group practices 3

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1841562907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691",
            "fax_number": "615-322-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N JACKSON ST STE 100",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882291",
            "telephone_number": "931-455-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KATHRYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "16415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528507",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kathryn.waller.2@5872.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1805 N Jackson St",
            "city": "Tullahoma",
            "state": "TN",
            "country_code": "US",
            "postal_code": "373882290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

Verify at the official NPI Registry.