Jessica Lynn Wallace, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

025.0112709 Issued in VT

Practice address

65 Cambrian Way Apt 110
Burlington, VT 05401-2970

Phone

(802) 503-8051

NPI assigned

Nov 5, 2021

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

Other names 1

• Jessica Lynn Hale Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1427713288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 CAMBRIAN WAY APT 110",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054012970",
            "telephone_number": "802-503-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 CAMBRIAN WAY APT 110",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054012970",
            "telephone_number": "802-503-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-05",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VT",
            "license": "025.0112709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HALE",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Walker, LCMHC
• Matthew W. Walker, M.D.
• Taylor R Walker
• Danielle Wall
• Harold James Wallace III, M.D.
• Morgan Roisin Wallace
• Allison Walling
• Marina Wallman
• Walsh Pcah LLC
• Katherine Anne Walsh, MD

• Licensed Practical Nurse in Burlington, VT
• Providers in Burlington, VT by specialty
• Licensed Practical Nurse in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.