Active NPI
Janet Ann Wallace, CNP
- Adult Health Nurse Practitioner
- Columbus, OH
National Provider Identifier
1235237819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- COA 05893
- Practice address
- 1699 W Mound St
Columbus, OH 43223-1809 - Phone
- (614) 263-5006
- Fax
- (614) 263-5019
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | COA 05893 | OH | Primary |
Addresses
Primary practice location
1699 W Mound St
Columbus, OH 43223-1809
Mailing address
1129 Norris Dr
Columbus, OH 43224-2734
Phone (614) 262-7758
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2305811 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA 05893 | OH | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268352000000",
"number": "1235237819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1129 NORRIS DR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432242734",
"telephone_number": "614-262-7758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1699 W MOUND ST",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432231809",
"telephone_number": "614-263-5006",
"fax_number": "614-263-5019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JANET",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2010-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "OH",
"license": "COA 05893",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2305811",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.