Active NPI
Laura Wallace, RN
- Registered Nurse
- Clinton, TN
National Provider Identifier
1699594788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 275332
- Practice address
- 710 N Main St
Clinton, TN 37716-3143 - Phone
- (865) 425-8800
- NPI assigned
- Oct 7, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 275332 | TN | Primary |
Addresses
Primary practice location
710 N Main St
Clinton, TN 37716-3143
Mailing address
124 Donna LN
Jacksboro, TN 37757-2729
Phone (423) 579-4539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 275332 | TN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1699594788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 DONNA LN",
"city": "JACKSBORO",
"state": "TN",
"postal_code": "377572729",
"telephone_number": "423-579-4539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 N MAIN ST",
"city": "CLINTON",
"state": "TN",
"postal_code": "377163143",
"telephone_number": "865-425-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LAURA",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-07",
"last_updated": "2024-10-07",
"certification_date": "2024-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TN",
"license": "275332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.