Nicolle S Walters, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY15949 Issued in CA

Practice address

77564 Country Club Dr
Suite 408
Palm Desert, CA 92211-0484

Phone

(760) 898-2968

Fax

(760) 345-3888

NPI assigned

Dec 5, 2006

Last updated

Jan 15, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238
  Medicare reassignment Care Compare group NPD
• Dan G. Walters, M.D. a Medical Corporation

  • Pulmonary Disease Physician
  • Palm Desert, CA
  • NPI 1255495446
  NPD (past)
• Sleepwise, Inc.

  • Sleep Disorder Diagnostic Clinic/Center
  • Palm Springs, CA
  • NPI 1639212749
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421280000000",
    "number": "1881752558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77564 COUNTRY CLUB DR",
            "address_2": "SUITE 408",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922110484",
            "telephone_number": "760-898-2968",
            "fax_number": "760-345-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77564 COUNTRY CLUB DR",
            "address_2": "SUITE 408",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922110484",
            "telephone_number": "760-898-2968",
            "fax_number": "760-345-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "NICOLLE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2015-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY15949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Everette Walker, PSY.D.
• Isabella Paje Wallace
• Walmart Inc. (WalMart Pharmacy 10-3026)
• Walmart Inc. (Walmart Pharmacy 10-5096)
• Walmart Stores, Inc. (Vision Center 30-5096)
• Elary Wanis
• Warby Parker Inc.
• Charlotte Wardwell
• Gabrielle Ware
• Angela Warren, PMHNP-BC, FNP-C

• Clinical Psychologist in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.