Brandy S Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

215880 Issued in LA

Practice address

6823 Saint Charles Ave BLDG 92
New Orleans, LA 70118-5665

Phone

(504) 865-5255

NPI assigned

Jan 22, 2020

Last updated

Oct 12, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bwallace@direct.mhg.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family

  Medicare reassignment NPD
• Hattiesburg Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Hattiesburg, MS
  • NPI 1164805156
  Medicare reassignment NPD
• Maxem Health Urgent Care Diberville

  • Urgent Care Clinic/Center
  • D'Iberville, MS
  • NPI 1265991608
  Medicare reassignment NPD
• Petal Urgent Care LLC

  • Urgent Care Clinic/Center
  • Petal, MS
  • NPI 1982908877
  Medicare reassignment NPD
• Relias Clinical Decision Specialists of Hattiesburg, LLC

  • Emergency Medicine Physician
  • Hattiesburg, MS
  • NPI 1336867415
  Medicare reassignment NPD
• Relias Emergency Medicine Specialists of Hattiesburg LLC

  • Emergency Medicine Physician
  • Hattiesburg, MS
  • NPI 1609409440
  Medicare reassignment NPD
• RH Hospitalist Medicine of Marion General LLC

  • Hospitalist Physician
  • Columbia, MS
  • NPI 1801660170
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1770113441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 COUNTY ROAD 127",
            "city": "QUITMAN",
            "state": "MS",
            "postal_code": "393559668",
            "telephone_number": "601-616-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6823 SAINT CHARLES AVE BLDG 92",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701185665",
            "telephone_number": "504-865-5255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 County Road 127",
            "address_purpose": "LOCATION",
            "city": "Quitman",
            "state": "MS",
            "postal_code": "393559668",
            "country_code": "US",
            "telephone_number": "601-616-1864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRANDY",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903712",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "215880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Steven Walker, PH. D.
• Ellen Wall
• Luke Allen Wall, M.D.
• Billy Micheal Wallace III
• Bobby Wallace, B.A.
• Jetavia Wallace
• Leslie Austin Wallace, MSW, LCSW
• Brittany Jill Wallen, PHARM.D.
• John Brent Wallis, MD
• Nathaniel Ross Wallo, LCSW

• Family Nurse Practitioner in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.