MR. KENNETH T WALLENFELSZ (ARNP) – Family Nurse Practitioner, NPI 1457649998
Family Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MR. KENNETH T WALLENFELSZ (ARNP)
620 RANCH RD
REEDSPORT, OR 974671720
Phone: (541) 271-2163
Fax: (541) 271-4058
Type: Mailing
3528 TONGASS AVE
KETCHIKAN, AK 999015635
Phone: (907) 220-4447
Fax: (949) 577-4111
Type: Mailing
834 Sheridan St
Port Townsend, WA 983682443
Phone: (360) 385-2200
Fax: (360) 385-3095
Type: Location
1274 7th St Ste A
Port Townsend, WA 983682404
Phone: (360) 385-2204
Fax: (360) 385-3095
Type: Location
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: 2014-12-30
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 |
|---|---|---|---|---|
| I20130104000244 | I | Nurse Practitioner | WA | TBD |
| I20141230000263 | I | Nurse Practitioner | TX | 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 97467)
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