Active NPI
Kristine Wallace, N.D.
- Naturopath
- Mesa, AZ
National Provider Identifier
1841742863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Naturopath
- License
- 16-1559
- Practice address
- 10153 N. Hampton Avenue
Suite 104
Mesa, AZ 85209 - Phone
- (480) 535-5688
- NPI assigned
- Oct 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Naturopath | 175F00000X | 16-1559 | AZ | Primary |
Addresses
Primary practice location
10153 N. Hampton Avenue
Suite 104
Mesa, AZ 85209
Mailing address
10153 N. Hampton Avenue
Suite 104
Mesa, AZ 85209
Phone (480) 535-5688
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-1559 | AZ | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477353600000",
"number": "1841742863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10153 N. HAMPTON AVENUE",
"address_2": "SUITE 104",
"city": "MESA",
"state": "AZ",
"postal_code": "85209",
"telephone_number": "480-535-5688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10153 N. HAMPTON AVENUE",
"address_2": "SUITE 104",
"city": "MESA",
"state": "AZ",
"postal_code": "85209",
"telephone_number": "480-535-5688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KRISTINE",
"name_prefix": "Dr.",
"credential": "N.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-25",
"last_updated": "2016-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "AZ",
"license": "16-1559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.