Charleston Bailee Wallace, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

30307 Issued in TN

Practice address

157 W Church St
Lexington, TN 38351-2011

Phone

(731) 968-8182

NPI assigned

Jun 18, 2021

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 TN

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

Memphis Hospital Medical College, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christopher D Marshall MD PLLCGroup PAC ID 5496071904, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henderson County Community Hospital Hospital, Lexington, TN, CCN 440008
• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Christopher D Marshall MD PLLC

  dba Medical Specialty Clinic

  • Rural Health Clinic/Center
  • Parsons, TN
  • NPI 1659762391
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428
  Care Compare affiliation
• Lexington Hospital Corporation

  dba Henderson County Community Hospital

  • General Acute Care Hospital
  • Lexington, TN
  • NPI 1255302923
  Care Compare affiliation

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1851960421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 NATCHEZ TRACE DR",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383511627",
            "telephone_number": "731-307-9413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 W CHURCH ST",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383512011",
            "telephone_number": "731-968-8182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "595 Natchez Trace Dr",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "TN",
            "postal_code": "383511627",
            "country_code": "US",
            "telephone_number": "731-307-9413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHARLESTON",
        "middle_name": "BAILEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "225188",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "30307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Volz
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0684)
• Wal-Mart Stores East, LP (Vision Center 30-0684)
• Walgreen Co (Walgreens #09678)
• Rachel Tyler Walker, FNP-C
• David Barton Waters, M.D.
• Alan Davis Weatherford, PA-C
• Megan Weatherford, PHARM. D.
• Wild Clarity Counseling
• Ida M Williams

• Family Nurse Practitioner in Lexington, TN
• Providers in Lexington, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.