Jordyn Wallace, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP024856 Issued in PA

Practice address

700 S Henderson Rd Ste 198
King of Prussia, PA 19406-3530

Phone

(267) 699-3900

NPI assigned

Jan 10, 2022

Last updated

Jan 10, 2022By the provider in NPPES

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 PA

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 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roy M Lerman M D P CGroup PAC ID 5890775878, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chester County Hospital Hospital, West Chester, PA, CCN 390179
• Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jordyn.wallace@mls.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Roy M Lerman MD PC

  dba Main Line Spine

  • Physical Medicine & Rehabilitation Physician
  • King of Prussia, PA
  • NPI 1215030812
  Medicare reassignment Care Compare group NPD
• Main Line Wellness LLC

  • Family Medicine Physician
  • King of Prussia, PA
  • NPI 1093357923
  NPD (past)

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

• Chester County Hospital

  • General Acute Care Hospital
  • West Chester, PA
  • NPI 1356333579
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Lankenau Hospital

  • General Acute Care Hospital
  • Wynnewood, PA
  • NPI 1245335629
  Care Compare affiliation

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1538810734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S HENDERSON RD STE 108",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S HENDERSON RD STE 198",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063530",
            "telephone_number": "267-699-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JORDYN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP024856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassiopoeia Walker-St.Felix
• Eric Roger Walker Jr., D.C.
• Georgette M Walker, M.S CCC-SLP
• Kristin Wooten Walker, C.N.M.
• Tyanna Walker, LBS
• William Wallace
• Rose Walley, RBT
• Zeena Walls
• Walnut Home Therapeutics, Inc (Jefferson Home Infusion Service and Jefferson Specialty Pharmacy)
• Megan Walsh, MS, BCBA

• Family Nurse Practitioner in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.