Wallace Dale Fox Jr., APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71007238A Issued in IN

Practice address

1400 Main St Unit 177
Clarksville, IN 47129-3108

Phone

(812) 946-2674

Fax

(844) 832-9625

NPI assigned

Jul 4, 2017

Last updated

Dec 19, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitalskin Medical Group Il PLLCGroup PAC ID 5991116261, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • New Albany, IN
  • NPI 1477297083
  Medicare reassignment Care Compare group NPD
• Mindbranch Mental Health Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Clarksville, IN
  • NPI 1801675491
  Authorized official Same address or phone
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1043731615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST UNIT 177",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471293108",
            "telephone_number": "812-946-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MAIN ST UNIT 177",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471293108",
            "telephone_number": "812-946-2674",
            "fax_number": "844-832-9625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOX",
        "first_name": "WALLACE",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-04",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71007238A",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71007238A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anita Louise Flohe, FNP
• Mallory Foote
• Tabitha Leigh Ford
• Emily Christine Foster, DNP, APRN
• Nina Fox
• Rachel L Fricke
• Kelly Fus, DNP
• Laura E Garrett, MS CCC-SLP
• Chad Phillip Garvey, PT
• Perla Gasser

• Psychiatric/Mental Health Nurse Practitioner in Clarksville, IN
• Providers in Clarksville, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.