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

Deven Waller

Individual provider Physician Assistant · NPI 1750165205

Deven Waller is a Physician Assistant in Albuquerque, New Mexico. Qualified in 2025, 1 year ago. Practices with Optumcare New Mexico LLC, a 72-clinician group and accepts Medicare assignment.

Years since qualifying
1
In the registry since
2023
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Practice location Address checks out

1500 N Renaissance Blvd NE Ste C
Albuquerque, NM 87107-7002
Phone: (505) 266-5565
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1750165205
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 23, 2023
Last updated in NPPESSeptember 3, 2025
Certification dateSeptember 3, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Optumcare New Mexico Llc — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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