Kristi Wallace, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

201050185NP Issued in OR

Practice address

74 E 18TH Ave
Ste 5
Eugene, OR 97401-4081

Phone

(541) 255-2248

Fax

(541) 735-3260

NPI assigned

Sep 22, 2010

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

Medicare fee-for-service enrollment

Enrolled in OR

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

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 and National Provider Directory roles.

• Bristol Advanced Illness Management - Oregon, L.L.C.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Springfield, OR
  • NPI 1083364749
  Medicare reassignment NPD
• Willamette Community Health Solutions

  • Diabetes Educator Registered Nurse
  • Eugene, OR
  • NPI 1255379566
  Medicare reassignment NPD
• Willamette Community Health Solutions

  • Physical Therapist
  • Eugene, OR
  • NPI 1649431636
  NPD
• Bristol Hospice - Eugene, LLC

  • Community Based Hospice Care Agency
  • Springfield, OR
  • NPI 1568962033
  NPD (past)
• Willamette Community Health Solutions

  • Community Based Hospice Care Agency
  • Eugene, OR
  • NPI 1093753386
  NPD (past)
• Willamette Community Health Solutions

  • Specialist
  • Eugene, OR
  • NPI 1477714467
  NPD (past)

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1851609945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 E 18TH AVE",
            "address_2": "STE 5",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014081",
            "telephone_number": "541-343-3455",
            "fax_number": "541-735-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 E 18TH AVE",
            "address_2": "STE 5",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014081",
            "telephone_number": "541-255-2248",
            "fax_number": "541-735-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KRISTI",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-22",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201050185NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Lynn Walker, MOA
• William Joshua Walker, PHARM/D
• Mary Wall
• Adam Wallace, EMT
• Diane Wallace, CADC II
• Leslie Michele Wallace, PT
• Melissa S Wallace, LPN
• Michelle Lynn Wallace, LMT
• Sharon Renee Wallace
• Linda Walling, CERTIFIED DOULA

• Family Nurse Practitioner in Eugene, OR
• Providers in Eugene, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.