Kimberly Wallace, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

290441 Issued in NY

Practice address

138 North Court Street
Wampsville, NY 13163

Phone

(315) 366-2490

NPI assigned

Oct 21, 2014

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

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": "1413849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413849600000",
    "number": "1750785622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 CLARK RD",
            "city": "CANASTOTA",
            "state": "NY",
            "postal_code": "130324759",
            "telephone_number": "315-396-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 NORTH COURT STREET",
            "city": "WAMPSVILLE",
            "state": "NY",
            "postal_code": "13163",
            "telephone_number": "315-366-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-21",
        "last_updated": "2014-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "290441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denice Ann Townsend, LPN
• Skylar Townsend, MHC-LP
• Marla S. Velky-Reger, LCSW
• Julie A Villa
• Maelea S Vonhunke, LCSW-R
• Julie A. Waterman, LCSW
• Leah Way, LMSW
• Ashley Marie Wilhelm
• Kaylee Williams, LCSW
• Gloriann Wixson, LMSW

• Licensed Practical Nurse in Wampsville, NY
• Providers in Wampsville, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; 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.