IndividualActive
Adam Waller, NP
NPI 1508476615 · Nurse Practitioner · West Frankfort, IL
Provider details
- NPI number
- 1508476615
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Male
- Sole proprietor
- Yes
- License
- 209021745 (IL)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
502 W Saint Louis St Ste 4
West Frankfort, IL 62896-1968
Phone: (618) 937-3400
Fax: (618) 997-9324
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 3988
Carbondale, IL 62902-3988
Additional practice locations (2)
- 2601 W Main StCarbondale, IL 62901-1031Phone: (618) 549-5361Fax: (618) 351-4878
- 405 Rushing DrHerrin, IL 62948-3730Phone: (618) 993-3300Fax: (618) 993-0262
Registry dates
- Enumerated
- 2020-08-04
- Last updated
- 2022-05-23
- Certified
- 2022-05-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.