Active NPI
Dustin W Wallace, CRNP
- Nurse Practitioner
- Birmingham, AL
National Provider Identifier
1275906158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1-133041
- Practice address
- 833 Princeton Ave SW
Pob III; Suite 200a
Birmingham, AL 35211-1323 - Phone
- (205) 786-2776
- NPI assigned
- Nov 2, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1-133041 | AL | Primary |
Addresses
Primary practice location
833 Princeton Ave SW
Pob III; Suite 200a
Birmingham, AL 35211-1323
Mailing address
833 Princeton Ave SW
Pob III; Suite 200a
Birmingham, AL 35211-1323
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446422400000",
"number": "1275906158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 PRINCETON AVE SW",
"address_2": "POB III; SUITE 200A",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352111323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "833 PRINCETON AVE SW",
"address_2": "POB III; SUITE 200A",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352111323",
"telephone_number": "205-786-2776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DUSTIN",
"middle_name": "W",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-11-02",
"last_updated": "2015-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AL",
"license": "1-133041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.