Catherine Wallace

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND4727 Issued in FL

Practice address

1320 Roberts Dr
Jacksonville Beach, FL 32250-3253

Phone

(904) 477-9882

NPI assigned

May 16, 2023

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1477244077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 4TH AVE N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504527",
            "telephone_number": "904-477-9882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 ROBERTS DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503253",
            "telephone_number": "904-477-9882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND4727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shabnam Wahid, PHARMD
• William Wainwright, MD
• Wal-Mart Stores East, LP (Vision Center 30-1172)
• Jessica Hope Walczak, PT, DPT
• Walgreen Co (Walgreens #04733)
• Richelle Walter, APRN
• Walters Chiropractic LLC
• Timothy Daniel Walters II, PT
• Michael Warhurst, D.O.
• Sarah Waters, RN, CCRN

• Registered Dietitian in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.