Nikki L Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

9725 Issued in TN

Practice address

110 29TH Ave N Ste 202
Nashville, TN 37203-1448

Phone

(615) 327-4304

NPI assigned

May 6, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104875459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 29TH AVE N STE 202",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031448",
            "telephone_number": "615-327-4304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 29TH AVE N STE 202",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031448",
            "telephone_number": "615-327-4304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 E Tickle St",
            "address_purpose": "LOCATION",
            "city": "Dyersburg",
            "state": "TN",
            "postal_code": "380243120",
            "country_code": "US",
            "telephone_number": "731-285-2410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NIKKI",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "9725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3627333",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4137445",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lee Wallace, PHARM.D., BCPS
• Juliet Paige Wallace, PHARM.D.
• Karen Wallace
• Kathryn Wallace
• Matthew Wallace
• Rodger T Wallace, M.D.
• Roy Trent Wallace, MD
• Sarah Wallace, PA
• Stuart C Wallace, CRNA
• Tift Palmer Wallace, CPNP

• Certified Registered Nurse Anesthetist in Nashville, TN
• Providers in Nashville, TN by specialty
• Certified Registered Nurse Anesthetist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.