Katherine Marie Wallace, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN243697 Issued in GA

Practice address

118 Enterprise CT Ste B
Columbus, GA 31904-9228

Phone

(706) 330-1389

Fax

(706) 330-1392

NPI assigned

Jan 28, 2015

Last updated

Jul 21, 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 2

Addresses

Other identifiers 1

Other names 1

• Katherine Marie Horne Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

University of Alabama School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Columbus Physical Medicine Center IncGroup PAC ID 5799920799, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: katherine.horne@cpmci-ga.direct.office.nextgen.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.

• Columbus Physical Medicine Center, Inc.

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1922346162
  Medicare reassignment Care Compare group NPD
• Columbus Joint Pain Solutions and Functional Medicine, LLC

  • Sports Medicine (Internal Medicine) Physician
  • Columbus, GA
  • NPI 1841056140
  Medicare reassignment NPD
• Anthony Vincent Ditaranto MD JD PC

  • Primary Care Clinic/Center
  • Columbus, GA
  • NPI 1801027008
  NPD (past)

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1548650617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 BETCHET LANE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368016153",
            "telephone_number": "334-750-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 ENTERPRISE CT STE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319049228",
            "telephone_number": "706-330-1389",
            "fax_number": "706-330-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATHERINE",
        "middle_name": "MARIE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AL",
            "license": "A0714020",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN243697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003161276B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "HORNE",
            "middle_name": "MARIE",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Annette Wallace
• Brenda Lee Wallace
• Carter Douglas Wallace, MD
• David C. Wallace
• Douglas W Wallace, MD
• Crystal Shanta Waller, CRNA
• Debbie Waller
• Nikki Alasandra Waller
• Stephanie Waller
• Shelley Walls, PHD, BCBA

• Adult Health Nurse Practitioner in Columbus, GA
• Providers in Columbus, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.