Amanda Gail Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.021126 Issued in OH

Practice address

247 Cic Blvd
West Union, OH 45693-7512

Phone

(513) 941-4999

Fax

(513) 694-0168

NPI assigned

Jul 21, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY, OH2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  KY, OH

  Medicare reassignment
• Amazing Grace Center Inc

  • Methadone Clinic
  • Portsmouth, OH
  • NPI 1205188588
  NPD

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1154844041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6460 HARRISON AVE STE 200",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477958",
            "telephone_number": "513-941-4999",
            "fax_number": "513-694-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 CIC BLVD",
            "city": "WEST UNION",
            "state": "OH",
            "postal_code": "456937512",
            "telephone_number": "513-941-4999",
            "fax_number": "513-694-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "GAIL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-21",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3011658",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.021126",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.300987",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1155351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0241010",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100477320",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert A Wahlbrink, MD
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walker Construction
• Rodney Paul Walker, CERTIFIED 15 YEARS
• Eric Clinton Wallace
• Maynell Wallace, LPCC
• Julia Watson
• Schannan Michelle Watson
• Gregg A Wells, MD

• Family Nurse Practitioner in West Union, OH
• Providers in West Union, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; 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.