Kyle Wilson Wallace, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN.423738 Issued in OH

Practice address

1715 Indian Wood Cir Ste 200
Maumee, OH 43537-4055

Phone

(937) 303-2710

NPI assigned

May 22, 2020

Sex

Male

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": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1124641394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4737 SADALIA RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436232965",
            "telephone_number": "734-731-7476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 INDIAN WOOD CIR STE 200",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435374055",
            "telephone_number": "937-303-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KYLE",
        "middle_name": "WILSON",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-22",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.423738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Waggoner, BCBA/MS
• Alan Wagner
• Ashley Wagner
• Bradley D Walker, QMHS
• Dena Walker
• Hunter Walters
• Kristel L Ward, DO
• Madison Elizabeth Warncke
• Eric Wayne Warnock, D.D.S
• Deborah Ann Warren, OTR/L

• Registered Nurse in Maumee, OH
• Providers in Maumee, OH by specialty
• Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; 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.