Lilianna Wallace, MBA, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

906 E 1St St
Thibodaux, LA 70301-6701

Phone

(985) 448-4805

NPI assigned

Apr 4, 2024

Last updated

Aug 20, 2026By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

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

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787184000000",
    "number": "1548012198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 E 1ST ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703016701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 E 1ST ST",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703016701",
            "telephone_number": "985-448-4805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LILIANNA",
        "credential": "MBA, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2026-08-20",
        "certification_date": "2026-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Louisiana Co Inc (Walgreens #04140)
• Juanita Lynn Walker, MS, PLPC
• Lance Paul Walker, MSN,FNP-BC AGACNP-BC
• Lerico Walker
• Nia Walker, PA-C
• Janay Ward
• Megan Jackson Warren, LPC-S
• Tania Collins Washington
• Wayne J Pharo a Professional Medical Corporation (The Heart Center of Lafourche)
• Theresa J Weary, PLPC

• Athletic Trainer in Thibodaux, LA
• Providers in Thibodaux, LA by specialty
• Athletic Trainer in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.