Tamara Jane Wallace, NP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

01255 Issued in OH

Practice address

700 Childrens Dr
Columbus, OH 43205-2664

Phone

(614) 361-8430

NPI assigned

May 9, 2008

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

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1073780045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6283 ENCLAVE BLVD",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827576",
            "telephone_number": "614-361-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-361-8430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5100 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432281607",
            "country_code": "US",
            "telephone_number": "614-544-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Olentangy River Rd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143908",
            "country_code": "US",
            "telephone_number": "614-566-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7500 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "OH",
            "postal_code": "430168518",
            "country_code": "US",
            "telephone_number": "614-544-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 S Grant Ave",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432154701",
            "country_code": "US",
            "telephone_number": "614-566-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TAMARA",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TN",
            "license": "APN0000015454",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "OH",
            "license": "01255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0201101",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELL CARE",
            "identifier": "606646",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TNCARE BLCARE",
            "identifier": "4299578",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129252",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003109104C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP GA",
            "identifier": "003109104C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicolas Wallace
• Peter Yarkpazuo Wallace
• Scott Christopher Wallace, MD
• Sekeshia Wallace
• Shannon May Wallace, NP
• Timothy Wallace Jr., EDD
• Travonti Scott Wallace
• Paul Ntoh Wallang
• Randi Walle
• Mark Allen Wallenbrock, M.D.

• Neonatal Nurse Practitioner in Columbus, OH
• Providers in Columbus, OH by specialty
• Neonatal Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; 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.