Brenda Wallis, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

072151 Issued in TX

Practice address

505 S John Redditt Dr
Lufkin, TX 75904-3120

Phone

(936) 639-3036

Fax

(936) 639-3064

NPI assigned

Jul 14, 2006

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Deep East Texas AnesthesiaGroup PAC ID 3971906587, 4 clinicians

Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Deep East Texas Anesthesia

  • Anesthesiology Physician
  • Nacogdoches, TX
  • NPI 1942879580

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Emergenchealth PLLC

  • Anesthesiology Physician
  • Fort Worth, TX
  • NPI 1467970897

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1477579688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151736",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759151736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S JOHN REDDITT DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043120",
            "telephone_number": "936-639-3036",
            "fax_number": "936-639-3064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "BRENDA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "072151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "84275U",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "84279U",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Texas, LLC.
• Walgreen Co
• Walgreen Co
• Jennifer Leigh Walker, ST
• Clintin Spencer Wallace
• Rebekah H Walsh
• Julianna Marie Walters, PT
• Kaitlyn Walters
• Wanner Enterprise
• Audrey Denise Ward

• Certified Registered Nurse Anesthetist in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; 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.