Active NPI
Tyrianne Wallace
- Case Manager/Care Coordinator
- Gretna, LA
National Provider Identifier
1083209209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1202 Monroe St
Gretna, LA 70053-2307 - Phone
- (504) 309-6798
- Fax
- (504) 407-2115
- NPI assigned
- Mar 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1202 Monroe St
Gretna, LA 70053-2307
Mailing address
7523 Avon Park Blvd
New Orleans, LA 70128-2101
Phone (504) 320-6978
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615248000000",
"number": "1083209209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7523 AVON PARK BLVD",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701282101",
"telephone_number": "504-320-6978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 MONROE ST",
"city": "GRETNA",
"state": "LA",
"postal_code": "700532307",
"telephone_number": "504-309-6798",
"fax_number": "504-407-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "TYRIANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-09",
"last_updated": "2021-03-09",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gretna, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.