Alexandrea Irene Wallace, MSN, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

1104891 Issued in TX

Practice address

4241 E Piedras Dr Ste 118
San Antonio, TX 78228-1422

Phone

(210) 301-0031

Fax

(210) 301-0031

NPI assigned

Dec 29, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing

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.

• A Wallace Mental Health Services, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • San Antonio, TX
  • NPI 1952164063
  NPD Authorized official

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

{
    "created_epoch": "1672272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1740993252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 NE LOOP 410 STE 315",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782165836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 E PIEDRAS DR STE 118",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281422",
            "telephone_number": "210-301-0031",
            "fax_number": "210-301-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALEXANDREA",
        "middle_name": "IRENE",
        "credential": "MSN, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-29",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1104891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1952164063",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florence E. Wall, PA-C
• Gay Huffman Wall, R.PH.
• Lauren C Wall
• Shawna R. Wall, MD
• Janna Wallace-Lennox, LMFT
• Alexandria Lynn Wallace, CPHT
• Andrew Wallace Jr.
• Annmarie Wallace, CRNA
• Ashley Wallace, DDS
• Chad Ryan Wallace, RN

• Psychiatric/Mental Health Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.

Verify at the official NPI Registry.