Susan P Walla, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

29650.1122 Issued in WY

Practice address

707 W 8TH St
Gillette, WY 82716-4108

Phone

(307) 685-8255

Fax

(888) 852-8319

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Counseling Connections, LLC

  • Community/Behavioral Health Agency
  • Gillette, WY
  • NPI 1689979361
  NPD (past)
• Eastern Montana Community Mental Health Center

  • Clinic/Center
  • Miles City, MT
  • NPI 1992786784

  Psychiatric/Mental Health

  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1962589747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "748 MAIN ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203036",
            "telephone_number": "307-332-2231",
            "fax_number": "307-332-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 W 8TH ST",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827164108",
            "telephone_number": "307-685-8255",
            "fax_number": "888-852-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLA",
        "first_name": "SUSAN",
        "middle_name": "P",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MT",
            "license": "21112",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WY",
            "license": "29650.1122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000439212",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136049300",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Wagner, PHARMD
• Joan M Wagner, PCSW, CAP, CAC, LMSW
• Wal-Mart Stores, Inc.
• Walgreen Co
• Walgreen Co.
• Walmart Inc.
• Jordyn Riley Walter, PA-C
• Kerry Elizabeth Warner, RN
• Tracy L Wasserburger, APRN
• Amy Darlene Weber, LPC

• Psychiatric/Mental Health Nurse Practitioner in Gillette, WY
• Providers in Gillette, WY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.