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

Mr. Richard Keith Waller, APRN

Individual provider Family Nurse Practitioner · NPI 1215770516

Mr. Richard Keith Waller, APRN is a Nurse Practitioner in Edgewood, Kentucky. Qualified in 2023, 3 years ago. Practices with Summit Medical Group Inc, a 799-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kentucky and Ohio.

Years since qualifying
3
Licensed in
KY, OH
In the registry since
2024
Specialties on file
2
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone: (859) 757-2927
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11135 Montgomery Rd, Cincinnati, OH 45249-2338 — (513) 791-7572

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 4047540 (KY)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 0036149 (OH)

Record details

NPI number1215770516
Entity typeIndividual (Type 1)
GenderMale
Credentials APRN
Sole proprietorNo
NPI enumeratedJune 14, 2024
Last updated in NPPESDecember 15, 2025
Certification dateDecember 15, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Summit Medical Group Inc — 799 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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