Courtney A Wallace, STNA

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

602590990223 Issued in OH

Practice address

125 Johns St Apt a
Wellington, OH 44090-1273

Phone

(440) 935-7827

NPI assigned

May 5, 2025

Last updated

May 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1609665736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 JOHNS ST APT A",
            "city": "WELLINGTON",
            "state": "OH",
            "postal_code": "440901273",
            "telephone_number": "440-935-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 JOHNS ST APT A",
            "city": "WELLINGTON",
            "state": "OH",
            "postal_code": "440901273",
            "telephone_number": "440-935-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COURTNEY",
        "middle_name": "A",
        "credential": "STNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Home Health Aide",
            "state": "OH",
            "license": "602590990223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Threads Within LLC
• Tina Renee Tucker
• Robin M. Twining, L.P.N.
• Lisa L Tylicki, PT
• Lori Renee Waite, LPN
• Michelle Marie Wallace I, R.N.
• Weber Health Care Center, Inc.
• Wellington Estates Inc (St Charles/St James Place)
• Wellington Estates Inc (Boardwalk & Parkplace)
• Wellington Exempted Village School District

• Home Health Aide in Wellington, OH
• Providers in Wellington, OH by specialty
• Home Health Aide in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; 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.