Aundrea Leighann Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

27443 Issued in TN

Practice address

103 Midlake Dr Uppr Level
Knoxville, TN 37918-3002

Phone

(865) 687-1973

Fax

(833) 908-2091

NPI assigned

Apr 15, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

East Tennessee State University Quillen College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aundrea.wallace.1@20785.direct.athenahealth.com

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

• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Brentwood, TN
  • NPI 1659090298
  Medicare reassignment Care Compare group NPD
• Cogent Healthcare of Tennessee, PC

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1952654246
  Medicare reassignment NPD
• Summit Medical Group, PLLC

  • Internal Medicine Physician
  • Knoxville, TN
  • NPI 1548349186
  NPD
• Summit Medical Group PLLC

  • Family Medicine Physician
  • Oak Ridge, TN
  • NPI 1437238797
  NPD (past)
• Summit Medical Group, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1699722470
  NPD (past)
• Renuven Health Partners of Georgia PC

  • Internal Medicine Physician
  • Fort Oglethorpe, GA
  • NPI 1871196519
  NPD (past)

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1053930404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091382",
            "telephone_number": "865-584-4747",
            "fax_number": "865-381-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MIDLAKE DR UPPR LEVEL",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379183002",
            "telephone_number": "865-687-1973",
            "fax_number": "833-908-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AUNDREA",
        "middle_name": "LEIGHANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "27443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Taylor Wall, MD
• Rachal Wall
• Ruth Wall, PTA
• Susan M Wall, DNP, APRN, FNP-BC
• Anna Hollmann Wallace, M.D.
• Elizabeth Ann Wallace, FNP-BC
• Heather Ann Wallace
• James Ryan Wallace, CRNA
• Jeffery Wallace
• Jessica Wallace, MA, NCC

• Family Nurse Practitioner in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.