Active NPI
Kimberly Wallace, LRN
- Registered Nurse
- Kennett, MO
National Provider Identifier
1114249117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2007032845
- Practice address
- 925 Highway V V
Kennett, MO 63857 - Phone
- (573) 888-5925
- Fax
- (573) 888-9365
- NPI assigned
- Feb 18, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2007032845 | MO | Primary |
Addresses
Primary practice location
925 Highway V V
Kennett, MO 63857
Mailing address
500 US Highway 61 North
Hayti, MO 63851
Phone (573) 359-2600
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007032845 | MO | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Past | Accepting new patients | |
| Family Counseling Center, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Hayti, MO
- NPI 1194026765
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Hayti, MO
- NPI 1750727640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266451200000",
"number": "1114249117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 US HIGHWAY 61 NORTH",
"city": "HAYTI",
"state": "MO",
"postal_code": "63851",
"telephone_number": "573-359-2600",
"fax_number": "573-359-1103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 HIGHWAY V V",
"city": "KENNETT",
"state": "MO",
"postal_code": "63857",
"telephone_number": "573-888-5925",
"fax_number": "573-888-9365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KIMBERLY",
"name_prefix": "Ms.",
"credential": "LRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-18",
"last_updated": "2010-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MO",
"license": "2007032845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennett, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.