Individual
MR. RICHARD KEITH WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1 MEDICAL VILLAGE DRIVE, EDGEWOOD, KY 41017-3403
(859) 757-2927
Mailing address
1 MEDICAL VILLAGE DRIVE, EDGEWOOD, KY 41017-3403
(859) 757-2927
(859) 341-0203
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4047540
KY
363LF0000X
Family Nurse Practitioner
0036149
OH
Other
Enumeration date
06/14/2024
Last updated
12/15/2025
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