Laury M Wallace, NP

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

71007724A Issued in IN

Practice address

16731 Gaither Blvd
Westfield, IN 46074-4607

Phone

(317) 561-6840

Fax

(812) 239-3771

NPI assigned

Jan 4, 2018

Last updated

Oct 6, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Life's Journey of Avon,LLC

  dba Life's Journey Hospice

  • Community Based Hospice Care Agency
  • Plainfield, IN
  • NPI 1629504303

  Corporate Director

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifes Journey Palliative Care

  dba Lifes Journey of Avon LLC

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Indianapolis, IN
  • NPI 1497417828
  Medicare reassignment
• Life's Journey of Avon,LLC

  dba Life's Journey Hospice

  • Community Based Hospice Care Agency
  • Plainfield, IN
  • NPI 1629504303

  Adolescent Medicine

  NPD (past)

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791244800000",
    "number": "1205343845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16731 GAITHER BLVD",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460744421",
            "telephone_number": "812-239-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16731 GAITHER BLVD",
            "city": "WESTFIELD",
            "state": "IN",
            "postal_code": "460744607",
            "telephone_number": "317-561-6840",
            "fax_number": "812-239-3771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3760 Mullan Rd",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598085123",
            "country_code": "US",
            "telephone_number": "406-551-2273",
            "fax_number": "406-551-2073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LAURY",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-04",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "IN",
            "license": "71007724A",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IN",
            "license": "71007724A",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "IN",
            "license": "71007724A",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "IN",
            "license": "71007724A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberlee A Wach, PT, DPT
• Catherine C Wagner, ED.S
• Walgreen Co (Walgreens #07618)
• Walgreen Co (Walgreens #10426)
• Ann Marie Walker, FNP-C
• Jennifer Wallner, RBT
• Elizabeth Walters, EDD, LAT, ATC, CES
• Lillian Wang, NP
• Jayme Adkins Wasserstrom, LCSW
• We Play ABA and Language Academy, LLC

• Adult Medicine Physician in Westfield, IN
• Providers in Westfield, IN by specialty
• Adult Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.