Kimberly Wallace, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

1-069756 Issued in AL

Practice address

204 Lowe Ave SE Ste 2
Huntsville, AL 35801-4242

Phone

(256) 534-7235

NPI assigned

Nov 7, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1104534395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3118 MALLARD POINT DR SE",
            "city": "OWENS CROSS ROADS",
            "state": "AL",
            "postal_code": "357638497",
            "telephone_number": "256-679-3281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 LOWE AVE SE STE 2",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014242",
            "telephone_number": "256-534-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "AL",
            "license": "1-069756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Wallace
• Barbara Wallace, LICSW
• Cynthia S. Wallace
• Jelisa Wallace, CRNP
• Kara Wallace, M.D.
• Rebbie Arptisha Wallace
• Somyr Waller, CRNA
• Lauren M. Walley, NP
• Sean Patrick Wallis, DC
• Morgan Whaley Walls, PT

• General Practice Registered Nurse in Huntsville, AL
• Providers in Huntsville, AL by specialty
• General Practice Registered Nurse in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.