Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Adam Waller, NP

Individual provider Nurse Practitioner · NPI 1508476615

Adam Waller, NP is a Nurse Practitioner in West Frankfort, Illinois. Qualified in 2020, 6 years ago. Practices with Logan Primary Care Service Corp, a 33-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Licensed in
IL
In the registry since
2020
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

502 W Saint Louis St Ste 4
West Frankfort, IL 62896-1968
Phone: (618) 937-3400
Fax: (618) 997-9324
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2601 W Main St, Carbondale, IL 62901-1031 — (618) 549-5361
  • 405 Rushing Dr, Herrin, IL 62948-3730 — (618) 993-3300

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 209021745 (IL)

Record details

NPI number1508476615
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorYes
NPI enumeratedAugust 4, 2020
Last updated in NPPESMay 23, 2022
Certification dateMay 23, 2022
Mailing addressPo Box 3988, Carbondale, IL 62902-3988

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Logan Primary Care Service Corp. — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in West Frankfort