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NPI Code Detail

MEDICARE: AMY K WALL NP

MEDICARE: AMY K WALL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner96546CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
223580OTHERCOKAISER COMMERCIAL NUMBER

General Provider Information

NPI Number : 1861711426
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY K WALL NP
Provider Business Mailing Address
First Line : 7951 E MAPLEWOOD AVE STE 350
Second Line :
City : GREENWOOD VILLAGE
State : CO
Zip : 80111-4758
Country : US
Telephone Number : 303-930-7803
Fax Number :
Provider Business Practice Location Address
First Line : 6031 E WOODMEN RD STE 200
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80923-2625
Country : US
Telephone Number : 719-577-2555
Fax Number : 719-597-6425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2010
Last Update Date : 10/04/2023

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