Bianca Nichole Wallace

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

9289 Issued in AR

Practice address

31 E Center St Ste 205
Fayetteville, AR 72701-5385

Phone

(479) 388-1513

NPI assigned

Aug 2, 2024

Last updated

Aug 2, 2024By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1063242337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 E CENTER ST STE 205",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015385",
            "telephone_number": "479-388-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 E CENTER ST STE 205",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015385",
            "telephone_number": "479-388-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BIANCA",
        "middle_name": "NICHOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AR",
            "license": "9289",
            "primary": true
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylee Walkingstick
• Lauren B Wall-Horn, D.C
• Calissa Mechel Wall
• Charles Earl Wall Jr., PA-C
• Angelika Marjorie Wallace
• Carla R Wallace, LCSW
• Dan L Wallace, LPC
• Logan Wallace
• Mykala R Wallace, LMSW
• Natalie Wallace

• Massage Therapist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Massage Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.