Aubrey Kathleen Wallace, N.D.

Primary specialty

NaturopathTaxonomy code 175F00000X

License

NT 60477240 Issued in WA

Practice address

21827 76TH Ave W Ste 202
Edmonds, WA 98026-7981

Phone

(425) 835-0359

Fax

(425) 835-0821

NPI assigned

Aug 30, 2007

Last updated

Aug 24, 2015By 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

Other identifiers 1

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": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1760676019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21827 76TH AVE W STE 202",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267981",
            "telephone_number": "425-835-0359",
            "fax_number": "425-835-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21827 76TH AVE W STE 202",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267981",
            "telephone_number": "425-835-0359",
            "fax_number": "425-835-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AUBREY",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "N.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "WA",
            "license": "NT 60477240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2046966",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Naturopath in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Naturopath in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; 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.