Waller, Kimberly L

Waller, Kimberly L is an individual health care provider with primary practice located at 1701 Nw Hawthorne Ave , Grants Pass OR 97526-1051. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Waller, Kimberly L can be contacted via phone (541) 471-3455.

Contact Information

Primary practice address
1701 Nw Hawthorne Ave Grants Pass OR 97526-1051
Phone: (541) 471-3455
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA842 Nevada
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA01142 Oregon

Profile Details

NPI number 1093782914
LBN Legal business name Waller, Kimberly L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated Oct 28th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093782914 NPPES
Nevada MEDICAID 100503581
Nevada MEDICAID 100503226

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