Teresa Wallace Tucker, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2014032763 Issued in MO

Practice address

2659 Piper Hills Dr
Belleville, IL 62221-3458

Phone

(757) 561-8878

NPI assigned

Nov 24, 2014

Last updated

Nov 24, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Teresa Alicia Wallace Former name

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": "1416787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416787200000",
    "number": "1215334016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2659 PIPER HILLS DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213458",
            "telephone_number": "757-561-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 PIPER HILLS DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213458",
            "telephone_number": "757-561-8878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "TERESA",
        "middle_name": "WALLACE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-24",
        "last_updated": "2014-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2014032763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERESA",
            "last_name": "WALLACE",
            "middle_name": "ALICIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Nurse in Belleville, IL
• Providers in Belleville, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; 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.