Stacey B Wall, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F300896 Issued in NY

Practice address

945 E Genesee St
Suite 200
Syracuse, NY 13210-1752

Phone

(315) 475-8401

Fax

(315) 475-0824

NPI assigned

Mar 10, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  NPD (past)

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1427299197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 E GENESEE ST",
            "address_2": "SUITE 200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101752",
            "telephone_number": "315-475-8401",
            "fax_number": "315-475-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 E GENESEE ST",
            "address_2": "SUITE 200",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101752",
            "telephone_number": "315-475-8401",
            "fax_number": "315-475-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "STACEY",
        "middle_name": "B",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-10",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F300896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter James Walker, PA-C
• Precious C Walker, LMT
• Stephanie Helen Walker, M.S.-CCC-SLP
• Tracy H Walker, FNP-C
• Kellie Faughander Wall, RD, CNSC, CDN
• Alyssa Marie Wallace, LMHC
• Danielle N Wallace, RPH
• Erin Wallace
• Kyrsten Wallace, MD
• Jason M Wallen, MD

• Adult Health Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.