Kelsey Spiller Wallace

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

27966 Issued in TN

Practice address

103 Suburban Rd Ste D102
Knoxville, TN 37923-5581

Phone

(865) 424-7334

Fax

(865) 263-8469

NPI assigned

Feb 1, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Koselig Health Services PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Knoxville, TN
  • NPI 1780382804

  Psychiatric/Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1285225300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SUBURBAN RD STE D102",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379235581",
            "telephone_number": "865-424-7334",
            "fax_number": "865-263-8469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SUBURBAN RD STE D102",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379235581",
            "telephone_number": "865-424-7334",
            "fax_number": "865-263-8469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELSEY",
        "middle_name": "SPILLER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-01",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "27966",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "27966",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Ryan Wallace, CRNA
• Jeffery Wallace
• Jessica Wallace, MA, NCC
• Judy C Wallace
• Kaley C Wallace, M.S., CCC-SLP
• Trevor A Wallace, PT
• Samantha Wallenstein, AU.D.,CCC-A
• Kerri Waller, M.S.
• Thomas Jordan Walley
• Amanda Walls

• Psychiatric/Mental Health Nurse Practitioner in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.