Tiffany Wallace, QMHP

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Practice address

5881 Ludington Dr
Virginia Beach, VA 23464-1546

Phone

(757) 288-1363

NPI assigned

Feb 24, 2022

Last updated

Feb 24, 2022By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1205582509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5881 LUDINGTON DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234641546",
            "telephone_number": "757-288-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5881 LUDINGTON DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234641546",
            "telephone_number": "757-288-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TIFFANY",
        "credential": "QMHP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-02-24",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6728",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiyosia Wallace
• Marsha Wallace
• Nicole Marie Wallace, PT
• Quanesha Wallace, LPC-R
• Shayla Wallace
• Ian T Walloch
• Kaitlin Suzanne Walsh, MSED
• Madeline Walsh
• Marisa Lyn Walsh, OTR/L
• Samantha Elizabeth Walsh, PHARMACY TECHNICIAN

• Home Health Agency in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.