Alyssa Ann Wallace

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

4103 S Yale Ave Ste B
Tulsa, OK 74135-6002

Phone

(918) 382-7300

Fax

(918) 392-3471

NPI assigned

Oct 6, 2022

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

• Alyssa Ann Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1275258717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 700360",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741700360",
            "telephone_number": "918-382-7300",
            "fax_number": "918-392-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 S YALE AVE STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356002",
            "telephone_number": "918-382-7300",
            "fax_number": "918-392-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALYSSA",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "WALLACE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timber Walkingstick
• Andrea S. Wall, ACNP
• Dawn Marie Wall, NP-C
• Adam Joseph Wallace, M.D.
• Alexa Nicole Wallace, MS, RD, LD
• Annette S. Wallace, LPC
• Arthur G Wallace Jr., DO
• Carrie Wallace
• Christa Wallace
• Dacia Lanora Wallace

• Case Manager/Care Coordinator in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.