Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

KELLY R WALTER
NPI 1447196183
Nurse Practitioner in Decatur, IL

Q: What is Kelly Walter's NPI number?

The NPI number for Kelly Walter is 1447196183. It was assigned to this individual provider in the NPPES registry on April 27, 2026.

Q: What is Kelly Walter's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Walter was last updated on October 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 days 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.

Active since April 27, 2026

1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521(217) 422-6100(833) 784-5326 Get Directions Write a Review

NPPES record last updated: October 16, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 16, 2026, Apr 27, 2026 (2 updates tracked since 2026).

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About Kelly R Walter NPPES

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

KELLY R WALTER (NPI 1447196183) is an individual nurse practitioner in Decatur, Illinois, licensed in Illinois (209036734) and active in the NPI registry since April 2026. She maintains a secondary practice location in Decatur.

NPPES Registry Identity

NPI1447196183

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameKELLY R WALTER

Location Address1770 E LAKE SHORE DR STE 105Decatur, IL 62521-3800

Mailing Address1770 E Lake Shore Dr Ste 105Decatur, IL 62521-3800 · (217) 422-6100 · Fax (833) 784-5326

Phone(217) 422-6100

Fax(833) 784-5326

Sole ProprietorYes

Enumeration DateApril 27, 2026

Last NPPES UpdateOctober 16, 20262 updates tracked since enumeration

NPPES CertifiedOctober 16, 2026

✔ NPI 1447196183 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IL · 209036734

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1770 E LAKE SHORE DR STE 105, Decatur, IL 62521

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Secondary Practice Location 1

Location 14662 Dogwood CtDecatur, IL 62526-9326 · Phone (217) 413-7519

Other Providers at the Same Location NPPES 13

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

DR. JEANNE MARIE KAIROUZ MD

Internal Medicine (Cardiovascular Disease)