Jenelle Wallis, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

124001 Issued in AR

Practice address

10100 Kanis Rd
Little Rock, AR 72205-6202

Phone

(501) 255-6000

Fax

(501) 255-6400

NPI assigned

Mar 3, 2020

Last updated

Mar 3, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in AR

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Vincent Infirmary Medical CenterGroup PAC ID 5698674166, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI-St Vincent Infirmary Hospital, Little Rock, AR, CCN 040007
• Howard Memorial Hospital Hospital, Nashville, AR, CCN 041311

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwallis458804@direct.stlukeshealth.org

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.

• St. Vincent Infirmary Medical Center

  dba St Vincent North Anesthesia Group

  • Certified Registered Nurse Anesthetist
  • Sherwood, AR
  • NPI 1316991847
  Medicare reassignment Care Compare group NPD
• Heart Clinic Arkansas

  • Cardiovascular Disease Physician
  • Little Rock, AR
  • NPI 1053367508
  NPD
• St Vincent Infirmary Medical Center

  dba St Vincent Infirmary Medical Center - GeroPsych Unit

  • Psychiatric Hospital Unit
  • Little Rock, AR
  • NPI 1710442801
  NPD
• St. Vincent Infirmary Medical Center

  dba St. Vincent Heart Clinic Arkansas

  • Medical Specialty Clinic/Center
  • Little Rock, AR
  • NPI 1023381738
  NPD
• St. Vincent Infirmary Medical Center

  dba St. Vincent Heart Clinic Arkansas

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1144590522
  NPD
• St Vincent Infirmary Medical Center

  dba St. Vincent Homecare

  • Home Health Agency
  • Little Rock, AR
  • NPI 1316924236
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Howard Memorial Hospital

  • Critical Access Hospital
  • Nashville, AR
  • NPI 1851484695
  Care Compare affiliation
• St Vincent Infirmary Medical Center

  dba St Vincent Infirmary Medical Center - GeroPsych Unit

  • Psychiatric Hospital Unit
  • Little Rock, AR
  • NPI 1710442801
  Care Compare affiliation
• St Vincent Infirmary Medical Center

  dba St. Vincent Health System

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1780684431
  Care Compare affiliation

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1386279032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056202",
            "telephone_number": "501-255-6000",
            "fax_number": "501-255-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 KANIS RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056202",
            "telephone_number": "501-255-6000",
            "fax_number": "501-255-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JENELLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AR",
            "license": "124001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ceon Evonne Waller
• Emily Katherine Waller, MD
• Larry Henle Waller, M.D.
• Lydia Waller, RN
• Jesse Walley
• Pamela Ann Wallis, CCC/SLP
• Valerie Ann Wallis, CRNA
• Brooke Contois Walls, PA-C
• Carroll Eugene Walls Jr., OTR/L
• Jennifer Walls

• Acute Care Nurse Practitioner in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Acute Care Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.