Michael Wallis, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN112816 Issued in LA

Practice address

1634 Elton Rd
Jennings, LA 70546-3614

Phone

(800) 893-9698

NPI assigned

Mar 10, 2014

Last updated

Jan 26, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PCP Urgent Care Holdings LLCGroup PAC ID 5092016816, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• PCP Urgent Care Holdings LLC

  dba Patient Plus Urgent Care

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1245601038
  Medicare reassignment Care Compare group NPD
• Hospital Service District 1 of East Baton Rouge Parish

  dba Lane Regional Medical Center-Professional

  • General Acute Care Hospital
  • Zachary, LA
  • NPI 1962437681
  Medicare reassignment NPD
• Jefferson Davis Emergency Group LLC

  • Emergency Medicine Physician
  • Jennings, LA
  • NPI 1043289572

  Nurse Practitioner

  Medicare reassignment NPD
• St Tammany Emergency Physicians Group LLC

  • Emergency Medicine Physician
  • Covington, LA
  • NPI 1891187654
  Medicare reassignment NPD
• Hospital Service District 1 of East Baton Rouge Parish

  dba Lane Regional Medical Center - Lane Health & Wellness Clinic

  • Psychiatry Physician
  • Zachary, LA
  • NPI 1679466577
  NPD
• Hospital Service District 1 of East Baton Rouge Parish

  • Gastroenterology Physician
  • Zachary, LA
  • NPI 1952878506
  NPD
• PCP Urgent Care Holdings LLC

  dba Patient Plus Urgent Care

  • Durable Medical Equipment & Medical Supplies
  • New Orleans, LA
  • NPI 1598657025
  NPD
• R.T. Royal Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baton Rouge, LA
  • NPI 1255705828
  NPD (past)
• The Hospital Service District of West Feliciana Parish Louisiana

  • Critical Access Hospital
  • Saint Francisville, LA
  • NPI 1164497533
  NPD (past)
• The Hospital Service District of West Feliciana Parish Louisiana

  • Critical Access Hospital
  • Saint Francisville, LA
  • NPI 1881729606
  NPD (past)

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579996800000",
    "number": "1285050690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 ELTON RD",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463614",
            "telephone_number": "800-893-9698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19900 Old Scenic Hwy Ste H",
            "address_purpose": "LOCATION",
            "city": "Zachary",
            "state": "LA",
            "postal_code": "707917368",
            "country_code": "US",
            "telephone_number": "225-570-2618",
            "fax_number": "225-570-8539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MICHAEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-10",
        "last_updated": "2020-01-26",
        "certification_date": "2020-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "RN112816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magen B Voiselle, SLP
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0386)
• Wal-Mart Stores Louisiana, LLC (Vision Center 30-0386)
• Walgreen Co (Walgreens #10577)
• Conkichi Walker
• Carolyn Washington
• Claude Kimball Watkins
• Brandi Lynn Welch, PHARMD
• Wellness Clinic Psychiatry, LLC
• West Behavioral, LLC

• Nurse Practitioner in Jennings, LA
• Providers in Jennings, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.