Wallis Dermatology Associates PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

H6685 Issued in TX

Legal business name

WALLIS DERMATOLOGY ASSOCIATES PLLC

Practice address

3535 N Fourth St Ste 400
Longview, TX 75605-0038

Phone

(903) 757-3881

Fax

(903) 757-5948

NPI assigned

Jul 19, 2007

Last updated

Feb 13, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elizabeth Bowen

Title

Credentialing Officer

Phone

(903) 503-7330

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Calderon, FNP

  • Nurse Practitioner
  • Marshall, TX
  • NPI 1538681754
  Medicare reassignment Care Compare group NPD
• Taylor Griffin Dickerson, MD

  • Dermatology Physician
  • Longview, TX
  • NPI 1154825974
  Medicare reassignment Care Compare group NPD
• Casey Renee English, APRN-CNP

  • Nurse Practitioner
  • Longview, TX
  • NPI 1780259135
  Medicare reassignment Care Compare group NPD
• Laura Paul Fite, M.D.

  • Dermatology Physician
  • Longview, TX
  • NPI 1861750416
  Medicare reassignment Care Compare group NPD
• Kandiss Elizabeth Hearn, APRN, FNP-C

  • Nurse Practitioner
  • Tyler, TX
  • NPI 1336774405
  Medicare reassignment Care Compare group NPD
• Tammi M Short, FNP-C

  • Nurse Practitioner
  • Longview, TX
  • NPI 1538137153
  Medicare reassignment Care Compare group NPD
• Robert Stanley Taylor III, MD

  • MOHS-Micrographic Surgery Physician
  • Longview, TX
  • NPI 1760441893
  Medicare reassignment Care Compare group NPD
• Luke Stewart Wallis, MD

  • Dermatology Physician
  • Longview, TX
  • NPI 1144724717
  Medicare reassignment Care Compare group NPD
• Mark S Wallis, M.D.

  • MOHS-Micrographic Surgery Physician
  • Longview, TX
  • NPI 1861489049

  Dermatology

  Medicare reassignment Care Compare group NPD
• Dorothy McKenzie Womack, FNP-C

  • Nurse Practitioner
  • Longview, TX
  • NPI 1003590282
  Medicare reassignment Care Compare group NPD
• Rachel Marie Smith, P.A.

  • Physician Assistant
  • Longview, TX
  • NPI 1851323919
  Medicare reassignment Care Compare group
• Devor O'Connor, MD

  • Dermatology Physician
  • Longview, TX
  • NPI 1811566250
  Medicare reassignment NPD

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1396945234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 400",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050038",
            "telephone_number": "903-757-3881",
            "fax_number": "903-757-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 400",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050038",
            "telephone_number": "903-757-3881",
            "fax_number": "903-757-5948"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2365 Three Lakes Pkwy",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "75703",
            "country_code": "US",
            "telephone_number": "903-991-4569",
            "fax_number": "430-227-8328",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1900 S Washington Ave Ste E",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756706845",
            "country_code": "US",
            "telephone_number": "903-503-7330",
            "fax_number": "903-503-7336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WALLIS DERMATOLOGY ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "903-503-7330"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "H6685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302333501",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwallis@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Nextech direct address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3535 N Fourth St Ste 400",
            "city": "Longview",
            "state": "TX",
            "country_code": "US",
            "postal_code": "756050038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jaley Jeanette Wallace, LMT
• James Kenneth Wallace, CRNA
• Kimberley R Wallace, LCDC
• Sharon Wallace
• Wendy Jo Wallace, RDN
• Luke Stewart Wallis, MD
• Mark S Wallis, M.D.
• April Elaine Walnofer, DO
• Maureen Walston
• Valenitta Walter Sneed

• Dermatology Physician in Longview, TX
• Providers in Longview, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.