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HOLLY ANNA WALLER APN
NPI 1083440077
Nurse Practitioner - Psychiatric/Mental Health in Pueblo, CO

Active since September 09, 2024PECOS EnrolledAccepts Medicare Assignment
1600 W 24TH ST, PUEBLO, CO 81003(719) 546-4000 Get Directions Write a Review

NPPES record last updated: September 5, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Sep 5, 2025, Sep 9, 2024 (2 updates tracked since 2024).

About Holly Anna Waller Apn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HOLLY ANNA WALLER APN (NPI 1083440077) is an individual psychiatric/mental health provider in Pueblo, Colorado, licensed in Colorado (APN.1000132-NP) and active in the NPI registry since September 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1083440077
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameHOLLY ANNA WALLERCredential: APN
Location Address1600 W 24TH STPueblo, CO 81003-1411
Mailing Address1600 W 24th StPueblo, CO 81003-1411 · (719) 671-3023
Phone(719) 546-4000
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateSeptember 9, 2024
Last NPPES UpdateSeptember 5, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 5, 2025
✔ NPI 1083440077 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in CO · APN.1000132-NP
1600 W 24TH ST, Pueblo, CO 81003
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Holly Anna Waller Apn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9335664838
PECOS Enrollment IDI20250929001083
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Holly Waller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Impact Psychiatric Care, LLC
36 mi
Psychiatric/Mental Health
2993 BROADMOOR VALLEY RD STE 103
Colorado Springs, CO 80906
  • Reassigned Medicare billing, Colorado enrollment
  • 9 clinicians in this Medicare group
NPI 1871035543 (719) 301-7731

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 81003 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$89.43 typical visit price
range $58.06 – $174.82
Typical copayment $22.35 (range $14.51 – $43.70)
Most-billed visit code 99203
Established Patient
$102.03 typical visit price
range $18.88 – $142.79
Typical copayment $25.50 (range $4.72 – $35.69)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LARRY W. SALAS
Rehabilitation Practitioner
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4000
DR. ROBERT M. LONG M.D.
Psychiatry & Neurology (Psychiatry)
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4495
MARY E. WALKER-MESSER
Occupational Therapy Assistant
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4284
MR. JUAN CARLOS HERRAEZ SANCHEZ PA-C
Physician Assistant (Medical)
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4000
JIM RODRIGUEZ
Rehabilitation Practitioner
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4717
COLORADO MENTAL HEALTH INSTITUTE PUEBLO
Psychiatric Unit
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4000
ELLEN L. CORNETT OTR
Occupational Therapist
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4409
CAITLIN VIGIL MD
Psychiatry & Neurology (Forensic Psychiatry)
1600 W 24TH ST
PUEBLO, CO 81003
Pueblo County (719) 546-4000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Holly Waller's NPI number?

The NPI number for Holly Waller is 1083440077. It was assigned to this individual provider in the NPPES registry on September 9, 2024.

Where is Holly Waller located?

Holly Waller practices at 1600 W 24th St, Pueblo, CO 81003. The listed phone number is (719) 546-4000.

What is Holly Waller's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Holly Waller enrolled in Medicare?

Yes. Holly Waller is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Holly Waller's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Holly Waller reassigns Medicare benefits to Impact Psychiatric Care, LLC (Colorado Springs, CO). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Holly Waller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Holly Waller accept?

Health plans from Select Health list Holly Waller as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Holly Waller was last updated on September 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.