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NPI Code Detail

MEDICARE: KIMBERLY WALLERIUS APRN

MEDICARE: KIMBERLY WALLERIUS APRN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.0040895OH

General Provider Information

NPI Number : 1881006492
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY WALLERIUS APRN
Provider Business Mailing Address
First Line : 721 MIAMI CHAPEL RD
Second Line :
City : DAYTON
State : OH
Zip : 45417-4650
Country : US
Telephone Number : 937-281-6800
Fax Number :
Provider Business Practice Location Address
First Line : 721 MIAMI CHAPEL RD
Second Line :
City : DAYTON
State : OH
Zip : 45417-4650
Country : US
Telephone Number : 937-281-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2014
Last Update Date : 02/02/2026

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