Active NPI
Adrienne Wallace
- Registered Nurse
- Weldon Springs, MO
National Provider Identifier
1245903863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2010010977
- Practice address
- 300 Breeze Park Dr.
Weldon Springs, MO 63304 - Phone
- (636) 720-3090
- NPI assigned
- Jul 29, 2021
- Last updated
- Jul 29, 2021
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2010010977 | MO | Primary |
Addresses
Primary practice location
300 Breeze Park Dr.
Weldon Springs, MO 63304
Mailing address
5072 Douglas Park Dr
Saint Peters, MO 63304
Phone (636) 720-3090
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2010010977 | MO | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1245903863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5072 DOUGLAS PARK DR",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "63304",
"telephone_number": "636-720-3090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 BREEZE PARK DR.",
"city": "WELDON SPRINGS",
"state": "MO",
"postal_code": "63304",
"telephone_number": "636-720-3090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ADRIENNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-29",
"last_updated": "2021-07-29",
"certification_date": "2021-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MO",
"license": "2010010977",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Weldon Springs, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.