Phyllis B Wallo, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

019636 Issued in LA

Practice address

7611 Maple St
Suite A1
New Orleans, LA 70118-5068

Phone

(504) 444-5640

NPI assigned

Mar 6, 2007

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

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Sara Mayo Healthcare Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Orleans, LA
  • NPI 1760436703
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288742400000",
    "number": "1831228543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 MAPLE ST",
            "address_2": "SUITE A1",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701185068",
            "telephone_number": "504-444-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 MAPLE ST",
            "address_2": "SUITE A1",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701185068",
            "telephone_number": "504-444-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLO",
        "first_name": "PHYLLIS",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2010-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "019636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1380661",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jetavia Wallace
• Leslie Austin Wallace, MSW, LCSW
• Brittany Jill Wallen, PHARM.D.
• John Brent Wallis, MD
• Nathaniel Ross Wallo, LCSW
• Allison Grace Walls, MD
• Elisa Istre Walls, FNP-C
• Tityana Marie Walls
• Allison Ramos Walsh
• Christina Smith Walsh

• Psychiatry Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; 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.