DR. KENNETH WILLIAM WALLER


Address: 100 Emancipation Dr, Hampton, VA 23667-0001
Phone: 7577229961

DR. KENNETH WILLIAM WALLER (NPI# 1518921238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1518921238
Entity Type Individual
Full Name DR. KENNETH WILLIAM WALLER
Credential M.D.
Practice Address 100 Emancipation Dr
Hampton
VA 23667-0001
Practice Telephone 7577229961
Practice Fax Number 7577266078
Mailing Telephone 7577229961
Mailing Fax Number 7577266078
Enumeration Date 2006-04-12
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor X

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
X 2081P0004X Physical Medicine & Rehabilitation
Specialization: Spinal Cord Injury Medicine
0101040108 VA Allopathic & Osteopathic Physicians
X 2084N0400X Psychiatry & Neurology
Specialization: Neurology
0101040108 VA Allopathic & Osteopathic Physicians

Other Providers KENNETH WALLER

NPI Name Taxonomy Address Enumeration
1841546959 Kenneth Russell Waller IIi Veterinarian 2015 Linden Dr, Room 2058, Madison, WI 53706-1100 2012-07-25

Office Location

Street Address 100 EMANCIPATION DR
City HAMPTON
State VA
Zip Code 23667-0001

Providers in the same location

NPI Name Taxonomy Address Enumeration
1073518916 Therese P Montoya Physical Medicine & Rehabilitation 100 Emancipation Dr, Hampton, VA 23667 2005-06-16
1285241570 Larry N. Wootten Psychologist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-09-30
1487266631 Jason Jemale Hall Counselor 100 Emancipation Dr, Hampton, VA 23667-0001 2020-08-19
1790395085 Caitlyn Moody Pharmacist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-08-03
1639788268 Shan S. Wong Psychologist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-07-29
1205454352 Charity Seitz Psychologist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-07-06
1629694617 Michael William Olsavicky Pharmacist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-06-25
1659997914 John David Kauffman Pharmacist 100 Emancipation Dr, Hampton, VA 23667-0001 2020-06-23
1790301406 Lineisha Williams Social Worker 100 Emancipation Dr, Hampton, VA 23667-0001 2020-06-18
1215557335 Katy Hughes Fedorko Physician Assistant 100 Emancipation Dr, Hampton, VA 23667-2906 2020-04-18
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1124447388 Brian Pho Bui Psychiatry & Neurology Hampton Veterans Affairs 100 Emancipation Dr, Hampton, VA 23667 2014-04-15
1275786741 Melissa Ann Palka Nurse Practitioner Hampton Va Medical Center, 100 Emancipation Dr., Hampton, VA 23667 2008-10-28
1639107741 Lawrence Monroe Brown Jr. Social Worker Hampton Vamc, 100 Emancipation Dr, Hampton, VA 23667 2006-06-29
1578528030 Harold Steven Smuckler Family Medicine Department of Veterans Affairs, Primary Care, 100 Emancipation Lane, Hampton, VA 23667 2006-04-19
1013978451 Donald Epstein Psychologist 1000 Emancipation Drive, Hampton, VA 23667 2006-03-28
1225098593 Maryanne Schaeffer Dietitian, Registered 100 Emancipation Drive, Hampton, VA 23667 2006-03-23
1376074773 Linda Carol Whitfield Case Manager/Care Coordinator 100 Emancipation Drive, Hampton, VA 23667 2017-03-27
1316217516 Wallace Danny Johnson IIi Occupational Therapist 100 Emancipation Drive, Hampton, VA 23667 2012-01-04
1386929164 Amber Mizuki Dietitian, Registered 100 Emancipation Drive, Bldg 116, Hampton, VA 23667 2011-10-12
1447549266 Irene Nanghui Yi Pharmacist 100 Emancipation Dr., Hampton Vamc, Hampton, VA 23667 2011-04-01
Find all providers in zip 23667

Taxonomy Information

Taxonomy Code 2081P0004X
Grouping Allopathic & Osteopathic Physicians
Classification Physical Medicine & Rehabilitation
Specialization Spinal Cord Injury Medicine

Taxonomy Definition

A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ACGME Accredited Residency Program Requirements: 1 year of training with 3-5 years in relevant specialty for a total of 4-6 years. ABMS Approved Subspecialty Certificate: (Physical Medicine and Rehabilitation)

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1932161171 Anthony Vincent Cassini Physical Medicine & Rehabilitation 100 Emancipation Dr, 590-128, Hampton, VA 23667-0001 2006-04-04
1154382547 Laurie Lindblom Physical Medicine & Rehabilitation 100 Emancipation Dr, 128, Hampton, VA 23667-0001 2006-03-28

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1417165143 Steven Deschner Physical Medicine & Rehabilitation 7489 Right Flank Rd, Suite 300, Mechanicsville, VA 23116-3845 2007-05-18
1326096470 Kenneth Edward Moore Physical Medicine & Rehabilitation Mcguire Vamc, 1201 Broad Rock Rd, Richmond, VA 23249 2006-05-04
1275928426 Elisabeth Katherine Acker Physical Medicine & Rehabilitation 1201 Broad Rock Blvd, Richmond, VA 23249-0001 2015-04-04
1295942332 Deborah Caruso Physical Medicine & Rehabilitation 1201 Broad Rock Blvd, Spinal Cord Injury, Richmond, VA 23249-0001 2007-05-17
1346355054 Lance L. Goetz Physical Medicine & Rehabilitation 1201 Broad Rock Blvd, Richmond, VA 23249-0001 2006-08-20
1386662203 Prabhakaran K Nambiar Physical Medicine & Rehabilitation 95 Medical Park Blvd, Petersburg, VA 23805-9280 2006-07-18
1770517807 Mcv Associated Physicians Physical Medicine & Rehabilitation 1250 E Marshall Street, Mcv Hospitals Vcu Medical Center, Richmond, VA 23298-0510 2006-07-11

Competitor

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City HAMPTON
Zip Code 23667

Improve Information

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Dataset Information

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.

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