Andrea Wallace, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

30782 Issued in TN

Practice address

5041 Goswell CV
Olive Branch, MS 38654-9189

Phone

(901) 517-2555

NPI assigned

Dec 9, 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

Medicare fee-for-service enrollment

Enrolled in TN, MS, AR3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stern Cardiovascular Center, PAGroup PAC ID 2860390275, 126 clinicians

Stern Cardiovascular Foundation, IncGroup PAC ID 8123200540, 111 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048
• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awallace23031@mlh.direct-ci.com

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.

• Stern Cardiovascular Center, PA

  • Cardiovascular Disease Physician
  • Germantown, TN
  • NPI 1699790311

  AR, MS

  Medicare reassignment Care Compare group NPD
• Stern Cardiovascular Foundation, Inc

  • Cardiovascular Disease Physician
  • Germantown, TN
  • NPI 1316242266

  AR, MS

  Medicare reassignment Care Compare group NPD
• Specialty Physician Group LLC

  • Cardiovascular Disease Physician
  • Germantown, TN
  • NPI 1174842181

  Family

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1497414213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 GOSWELL CV",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386549189",
            "telephone_number": "901-517-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5041 GOSWELL CV",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386549189",
            "telephone_number": "901-517-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANDREA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-09",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "30782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Jasmine Jeterra Walker
• Loreal Walker, LCSW
• Kamika Wall
• Rachel Walton
• Richard Edward Warden II, D.C.
• Stacy L Warden, PT
• Washington Group, PLLC
• Stacy Joi Washington-Hodges, BCBA, LBA, MA

• Family Nurse Practitioner in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.