Active NPI
Kimberly Wallace
- Registered Nurse
- Bronx, NY
National Provider Identifier
1265969133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 731730-1
- Practice address
- 3400 Bainbridge Ave
Bronx, NY 10467-2404 - Phone
- (917) 450-5763
- NPI assigned
- May 22, 2017
- 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 | 731730-1 | NY | Primary |
Addresses
Primary practice location
3400 Bainbridge Ave
Bronx, NY 10467-2404
Mailing address
4330 Ely Ave
Bronx, NY 10466-1816
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 |
|---|---|---|---|
| 731730-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1495411200000",
"number": "1265969133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4330 ELY AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104661816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 BAINBRIDGE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104672404",
"telephone_number": "917-450-5763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-22",
"last_updated": "2017-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "731730-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.