Heather E Wallace

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

RN197918 Issued in GA

Practice address

535 Coliseum Dr
Macon, GA 31217-0104

Phone

(478) 972-0277

NPI assigned

Dec 21, 2016

Last updated

Dec 27, 2016By the provider in NPPES

Sex

Female

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 GA

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

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.

• Oconee Healthcare Center LLC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1306904081
  Medicare reassignment NPD
• Oconee Health Care Center LLC

  • Long Term Care Hospital
  • Macon, GA
  • NPI 1891049102
  NPD (past)

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

{
    "created_epoch": "1482278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1053856427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26698",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312216698",
            "telephone_number": "478-972-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 COLISEUM DR",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312170104",
            "telephone_number": "478-972-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HEATHER",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-21",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN197918",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN197918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha Jeanine Walker, BCBA
• Richard Alan Wall II
• Cleopatra Wallace, CRNA
• Danielle Wallace
• Franc Wallace, MD
• Lisa Marie Wallace, CRNA
• William Wallace Jr., MD
• Ryan C. Wallentine, PA-AA
• Waller Occupational Therapy and Consulting, LLC
• Eulanda Lara Waller, OTR/L

• Gerontology Nurse Practitioner in Macon, GA
• Providers in Macon, GA by specialty
• Gerontology Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.