Sara Wallace, LPA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

260061 Issued in KY

Practice address

11824 Ransum Dr
Louisville, KY 40243-2802

Phone

(502) 338-0608

Fax

(502) 245-1888

NPI assigned

Nov 11, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Be Well Providers, LLC

  • Adult Mental Health Clinic/Center
  • Louisville, KY
  • NPI 1568971950
  NPD (past)

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1447895776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11824 RANSUM DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432802",
            "telephone_number": "502-338-0608",
            "fax_number": "502-245-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11824 RANSUM DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402432802",
            "telephone_number": "502-338-0608",
            "fax_number": "502-245-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SARA",
        "credential": "LPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "260061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sara.wallace@bewellproviders.com",
            "affiliation": "N",
            "endpointDescription": "Confidential Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "11824 Ransum Dr",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402432802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kali Wallace, APRN
• Kiara Learlene Wallace, MD
• Melissa Wallace
• Rachel Wallace, NP
• Sandra Marie Wallace, PHARM.D.
• Shermeka Wallace
• Stephanie P Wallace, APRN
• Whitney R Wallace, COTA
• Robert John Wallander Jr., BCBA-D
• Joseph Wallen

• Clinical Psychologist in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; 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.