Harolyn Wallace, ANP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP122716 Issued in TX

Practice address

201 Mariposa
Alice, TX 78332-4177

Phone

(361) 664-8811

Fax

(361) 664-8992

NPI assigned

Mar 29, 2013

Last updated

Nov 19, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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.

• Physicians Referral Service

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1073574810
  NPD

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1104169911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12223 BROOKVALLEY DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770712702",
            "telephone_number": "832-724-4762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MARIPOSA",
            "city": "ALICE",
            "state": "TX",
            "postal_code": "783324177",
            "telephone_number": "361-664-8811",
            "fax_number": "361-664-8992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "HAROLYN",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-29",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "600813",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP122716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320242601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8396NA",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• VRL Inc
• Robert S Waer, MD
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0791)
• Wal-Mart Stores Texas, LLC (Wal-Mart Vision Center 30-0791)
• Walgreen Co (Walgreens #10231)
• Walter a. del Gallo, M.D.,P.a.
• West Wharton County Hospital District (Avir at Alice)
• Erin White, OTR
• Kendell R White, FNP-C
• Dean Delbert Wieben, D.C.

• Family Nurse Practitioner in Alice, TX
• Providers in Alice, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.