Laura Ann Wallace, A.P.N
Individual provider Active NPI Primary Care Nurse Practitioner · Pilot Knob, MO
NPI 1265737753 · NPPES record last updated Aug 7, 2025
Key facts
- NPI
- 1265737753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 2010037004 (MO)
- Practice address
- 301 N Highway 21
Pilot Knob, MO 63663-7862 - Phone
- (573) 546-8036
- Fax
- (573) 546-8067
- NPI assigned
- Jan 14, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Iron County Hospital District
Practice addresses (Care Compare)
301 N Hwy 21
Pilot Knob, MO 63663-7862
Phone (573) 546-0184
Hospital & facility affiliations
- Iron County Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 67.5 of 100
- Quality
- 53.06
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110802000333 | TN | Practitioner - Nurse Practitioner | 7416134036 | Reassigns benefits to 1 organization |
| I20260406001419 | MO | Practitioner - Nurse Practitioner | 7416134036 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2010037004 | MO | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crossroads Urgent Care PLLC | Family | Current |
Accepting new patients |
| Crossroads Urgent Care PLLC | Family | Current |
Accepting new patients |
| Ozarks Medical Center | Past | Accepting new patients | |
| Iron County Hospital District | Past | Accepting new patients | |
| West TN Medical, PLLC | Past | Accepting new patients |
Locations
2395 Lake Rd
Ste 7
Dyersburg, TN 38024
2445 Memorial Blvd
Ste C
Murfreesboro, TN 37129
Phone (615) 217-6900
30 Burton Hills Blvd
Ste 175
Nashville, TN 37215
Phone (615) 988-2014
Interoperability endpoints
- laura.wallace.1@16878.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 2010037004 | MO | Yes |
Addresses
Primary practice location
301 N Highway 21
Pilot Knob, MO 63663-7862
Mailing address
301 N Highway 21
Pilot Knob, MO 63663-7862
Phone (573) 546-8036
Other providers in Pilot Knob, MO
- Shepherd Mountain Emergency Physicians
- Phillip Starnes
- Kylie Renee Strange
- True Care Home Health Equipment Sales and Service LLC
- Kathern Marie Twidwell
- Michelle Whited
- Worden Chiropractic and Health
- Joseph Donald Worden III
All providers in Pilot Knob, MO · Primary Care Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.