Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Kimberly L Waller, PA-C

Individual provider Medical Physician Assistant · NPI 1093782914

Mrs. Kimberly L Waller, PA-C is a Physician Assistant in Grants Pass, Oregon. Qualified in 1997, 29 years ago. Practices with Siskiyou Community Health Center Inc, a 31-clinician group and accepts Medicare assignment. Licensed in Nevada and Oregon.

Years since qualifying
29
Licensed in
NV, OR
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone: (541) 471-3455
Show map & directions

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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA01142 (OR)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA842 (NV)

Record details

NPI number1093782914
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 1, 2006
Last updated in NPPESOctober 28, 2019

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Siskiyou Community Health Center Inc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients46
Services billed 215 a service is one billed item, such as a visit, a test or a procedure
Average patient age74

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician. Those with a page here are linked.

Colleagues at Siskiyou Community Health Center Inc

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 31 clinicians in the practice; 12 are shown here.

Other providers in Grants Pass