Camille Anne Wallace, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

354716 Issued in NY

Practice address

404 Zena Rd Ste 1
Woodstock, NY 12498-2627

Phone

(845) 679-5271

NPI assigned

Jun 5, 2024

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 NY

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

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nuvance Health Medical Practice PCGroup PAC ID 1658468442, 578 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Archcare at Home Home health agency, Valhalla, NY, CCN 337140
• Vassar Brothers Medical Center Hospital, Poughkeepsie, NY, CCN 330023
• Healthalliance Hospital Marys Avenue Campus Hospital, Kingston, NY, CCN 330224

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Nuvance Health Medical Practice PC

  • Internal Medicine Physician
  • Poughkeepsie, NY
  • NPI 1437358033
  Medicare reassignment Care Compare group NPD
• Health Quest Medical Practice, PC

  • Diagnostic Radiology Physician
  • Kingston, NY
  • NPI 1558906610
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Healthalliance Hospital Marys Avenue Campus

  • General Acute Care Hospital
  • Kingston, NY
  • NPI 1932182599
  Care Compare affiliation
• The Dominican Sisters Family Health Service Inc

  • Home Health Agency
  • Valhalla, NY
  • NPI 1821184839
  Care Compare affiliation
• Vassar Brothers Hospital

  • General Acute Care Hospital
  • Poughkeepsie, NY
  • NPI 1740233899
  Care Compare affiliation
• Vassar Brothers Medical Center

  • Clinical Medical Laboratory
  • Poughkeepsie, NY
  • NPI 1780052514

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720051200000",
    "number": "1720829468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BIRCH ST APT 18K",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011077",
            "telephone_number": "845-489-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 ZENA RD STE 1",
            "city": "WOODSTOCK",
            "state": "NY",
            "postal_code": "124982627",
            "telephone_number": "845-679-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CAMILLE",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-07-04",
        "certification_date": "2024-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Robert Thurman, LMHC
• Eric Tischler, L.AC.
• Michael Tischler, D.D.S.
• Veronica Vaganov, LMSW
• Natasha Vladick, RPH
• Aileen Walsh, LCSWR
• Kerrie-Anne Weickert, MHC-LP
• Kaitlyn Paige Wesolowski, PA-C
• Heidi Wettels, D.D.S
• Whole Person Physical Therapy PLLC

• Family Nurse Practitioner in Woodstock, NY
• Providers in Woodstock, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2024; 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.