SUSAN P WALLA (NPI# 1962589747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962589747 |
| Entity Type | Individual |
| Full Name | SUSAN P WALLA |
| Credential | APRN |
| Practice Address |
707 W 8th St Gillette WY 82716-4108 |
| Mailing Address |
748 Main St Lander WY 82520-3036 |
| Practice Telephone | 3076858255 |
| Practice Fax Number | 8888528319 |
| Mailing Telephone | 3073322231 |
| Mailing Fax Number | 3073322231 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-08-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
29650.1122 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
21112 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 136049300 | 05 | |
| MT | 0000439212 | 05 |
| Street Address |
707 W 8TH ST |
| City | GILLETTE |
| State | WY |
| Zip Code | 82716-4108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376947770 | Heather Schmelzle | Counselor | 707 W 8th St, Gillette, WY 82716 | 2014-10-14 |
| 1366878977 | Adonai Mental Health Services | Clinic/Center | 707 W 8th St, Gillette, WY 82716-4108 | 2013-09-16 |
| 1689979361 | Counseling Connections, LLC | Community/Behavioral Health | 707 W 8th St, Gillette, WY 82716-4108 | 2011-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053822387 | Diana Lynn Ohman | Dietitian, Registered | 709 West Eighth Street, Suite 4, Gillette, WY 82716 | 2017-10-13 |
| 1821457821 | Courage To Change Counseling LLC | Community/Behavioral Health | 113 S. Gillette Ave, Gillette, WY 82716 | 2016-02-18 |
| 1003290594 | Kris Huber | Community/Behavioral Health | 905 Gurley Ave, Gillette, WY 82716 | 2015-07-14 |
| 1649516857 | Shirley L Haley | Nurse Practitioner | 1304 West 4th Street, Gillette, WY 82716 | 2012-12-14 |
| 1174867188 | Rebecca J Mader | Registered Nurse | 501 South Burma Ave., Gillette, WY 82716 | 2012-11-15 |
| 1568728228 | Kerry Elizabeth Warner | Registered Nurse | 201 S Burma Ave, Gillette, WY 82716 | 2012-04-07 |
| 1720363351 | Julie Ann Faldalen | Licensed Practical Nurse | 501 South Burma, Gillette, WY 82716 | 2011-10-14 |
| 1083937486 | Clear Creek Counseling LLC | Counselor | 801 E. 4th St., Suite 24, Gillette, WY 82716 | 2010-03-12 |
| 1821241423 | Dianna L Knox | Counselor | 500 S Burma Ave, Gillette, WY 82716 | 2008-10-28 |
| 1588826887 | Scott R Hunter | Chiropractor | 439 Prairie View Place Ste D, Dr S R Hunter, Gillette, WY 82716 | 2008-06-27 |
| Find all providers in zip 82716 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295291102 | New Horizons Nichole Taylor Pmhnp-bc | Nurse Practitioner | 2001 W Lakeway Rd Ste C, Gillette, WY 82718-5774 | 2019-02-15 |
| 1730450032 | Bailey Psychiatric & Mental Health Services, LLC | Nurse Practitioner | 405 W Boxelder Rd, Suite C-8, Gillette, WY 82718-5320 | 2012-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912511981 | Nurture Mental Health & Wellness Center LLC | Nurse Practitioner | 125 S King St Ste 2a, Jackson, WY 83001-8124 | 2020-09-07 |
| 1639701899 | A Beautiful Mind LLC | Nurse Practitioner | 145 S Durbin St Ste 207, Casper, WY 82601-2566 | 2020-02-06 |
| 1932742210 | Timothy Joseph Barnes | Nurse Practitioner | 1617 Evans Ave Apt 1, Cheyenne, WY 82001-4698 | 2019-10-19 |
| 1639729056 | Sherra Stclair | Nurse Practitioner | 121 E Grand Ave Ste 204, Laramie, WY 82070-3600 | 2019-09-17 |
| 1528558004 | Open Range Telepsychiatry LLC | Nurse Practitioner | 30 N Gould St Ste 7141, Sheridan, WY 82801-6362 | 2018-05-10 |
| 1093117210 | Teecee Ann Hailey-fulfer | Nurse Practitioner | 770 W Collins Dr Ste 200, Casper, WY 82601-2300 | 2014-09-18 |
| 1831505262 | Advanced Practice, LLC | Nurse Practitioner | 733 Big Horn Ave, Suite 1, Worland, WY 82401-2605 | 2014-07-07 |
| 1629320775 | Sunlight Psychiatry | Nurse Practitioner | 145 N Bernard St, Powell, WY 82435-2617 | 2012-10-12 |
| 1750658944 | Jenny M Heuck | Nurse Practitioner | 1400 Pioneer Rd, Sheridan, WY 82801-3334 | 2011-11-16 |
| 1932427671 | Miriam A Davidson | Nurse Practitioner | 350 City View Dr Ste 302, Evanston, WY 82930-5307 | 2010-05-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.