Kelli Ann Wallace, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024184388 Issued in VA

Practice address

101 Holbrook St
Danville, VA 24541-1759

Phone

(434) 792-7765

NPI assigned

May 25, 2022

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 VA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Universal Health Corporation

  • Internal Medicine Physician
  • Roanoke, VA
  • NPI 1407117625
  Medicare reassignment NPD
• OB-GYN Associates of Danville

  • Specialist
  • Danville, VA
  • NPI 1134285869
  NPD (past)

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1558009936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOLBROOK ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HOLBROOK ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411759",
            "telephone_number": "434-792-7765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELLI",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024184388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arrisa Walker, PMHNP-BC
• Rebecca C Walker, RPH
• Takessa Walker
• Walker's Home Healthcare Corporation
• Cameron Wallace
• Lucy G Wallace
• Colby Wayne Waller
• Jessica Waller
• Thelbert Juwon Waller
• Ann Walsh

• Family Nurse Practitioner in Danville, VA
• Providers in Danville, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.