Stacy L Wallace, RD

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

855077 Issued in TX

Practice address

20330 Huebner Rd
Suite 104
San Antonio, TX 78258-3508

Phone

(832) 237-3500

Fax

(832) 237-0200

NPI assigned

Apr 2, 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

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.

• Dcoa Physician Associates PA

  • Medical Specialty Clinic/Center
  • San Antonio, TX
  • NPI 1538370572
  NPD (past)
• Dcoa Physicians PA

  • Medical Specialty Clinic/Center
  • Katy, TX
  • NPI 1023228699
  NPD (past)

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1487896668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11321 FALLBROOK DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770654232",
            "telephone_number": "832-237-3500",
            "fax_number": "832-237-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20330 HUEBNER RD",
            "address_2": "SUITE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583508",
            "telephone_number": "832-237-3500",
            "fax_number": "832-237-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "TX",
            "license": "855077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Kowalski Wallace, M.D
• Mary Wallace, M.S, LPC
• Melodie Kay Wallace, O.D.
• Norma Leticia Wallace, RN
• Stacy Wallace, NP
• Tammy Wallace, M.S. CF-SLP
• Tara Wallace
• Tim Wallace
• Yvette M Wallace, PT
• Amy Matson Walldren, LMSW

• Metabolic Nutrition Registered Dietitian in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Metabolic Nutrition Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.