Alexandria Wallace

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-143113 Issued in AL

Practice address

4810 Whitesport Cir SW Ste 110
Huntsville, AL 35801-7439

Phone

(205) 977-9876

Fax

(205) 977-9976

NPI assigned

Dec 14, 2018

Last updated

Mar 31, 2026By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Aqua Dermatology of Alabama PCGroup PAC ID 9436211463, 42 clinicians

Comprehensive Primary and Urgent Care of Alabama, LLCGroup PAC ID 1254741515, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comprehensive Primary & Urgent Care of Alabama, LLC

  • Primary Care Clinic/Center
  • Athens, AL
  • NPI 1750997706
  Medicare reassignment Care Compare group NPD
• Aqua Dermatology of Alabama PC

  dba Sunrise Dermatology

  • MOHS-Micrographic Surgery Physician
  • Vestavia HLS, AL
  • NPI 1477708642
  Medicare reassignment Care Compare group
• Jere H. Weaver

  • Dermatology Physician
  • Decatur, AL
  • NPI 1851573778
  NPD (past)

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

{
    "created_epoch": "1544745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1811468135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 W MARKET ST STE C",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356112463",
            "telephone_number": "256-444-1815",
            "fax_number": "256-444-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 WHITESPORT CIR SW STE 110",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358017439",
            "telephone_number": "205-977-9876",
            "fax_number": "205-977-9976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "802 Bank St NE",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "AL",
            "postal_code": "356011612",
            "country_code": "US",
            "telephone_number": "205-977-9876",
            "fax_number": "205-977-9976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALEXANDRIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-14",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-143113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Sue Walker, LPC, NCC, CAC
• Carol P. Walker,, PH.D
• Cynthia Wall, CRNP
• Samantha D Wall, CNM
• Abigail Wallace, BCBA
• Barbara Wallace, LICSW
• Cynthia S. Wallace
• Jelisa Wallace, CRNP
• Kara Wallace, M.D.
• Kimberly Wallace, RN

• Family Nurse Practitioner in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; 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.