KIMBERLY GLENDORIA WALLEN (CRNA) – Anesthesiology Physician, NPI 1033575907
Anesthesiology Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
710 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in IN
Provider Addresses for KIMBERLY GLENDORIA WALLEN (CRNA)
4170 FROST GRASS DR
FORT WAYNE, IN 468458009
Phone: (804) 647-1635
Type: Mailing
5734 COVENTRY LN
FORT WAYNE, IN 468047141
Phone: (260) 432-9812
Type: Location
600 Mt Highway 91 S
Dillon, MT 597257379
Phone: (406) 683-3000
Type: Location
3334 MONIDA ST
BOZEMAN, MT 597188648
Phone: (804) 647-1635
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200217003417 | I | Certified Registered Nurse Anesthetist (Crna) | MT | TBD |
| I20241119002105 | I | Certified Registered Nurse Anesthetist (Crna) | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46845)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| CERTIFIED REGISTERED NURSE ANESTHET | IN | 76942 | Ultrasonic guidance imaging supervision and interpretation for insertion of needle | 12 | 12 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MN | |
| Nurse Practitioner | MN | |
| - | MN | |
| Nurse Practitioner | MN | |
| Family Practice | MN | |
| H O S P I T A L I S T | MN | |
| Nurse Practitioner | MN | |
| Internal Medicine, Hospitalist, Internal Medicine | FL | |
| Family Practice | MN | |
| P O D I A T R Y | FL |
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