Lee S. Wallace, MS, RD, LDN, FADA

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

LDN0000000356 Issued in TN

Practice address

711 Jefferson Ave
Memphis, TN 38105-5003

Phone

(901) 448-6511

Fax

(901) 448-7097

NPI assigned

Jul 14, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

• University of Tennessee

  dba Center on Developmental Disabilities

  • Developmental Disabilities Clinic/Center
  • Memphis, TN
  • NPI 1427064880
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1861418535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381055003",
            "telephone_number": "901-448-6511",
            "fax_number": "901-448-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381055003",
            "telephone_number": "901-448-6511",
            "fax_number": "901-448-7097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LEE",
        "middle_name": "S.",
        "name_prefix": "Ms.",
        "credential": "MS, RD, LDN, FADA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "TN",
            "license": "LDN0000000356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquel Wallace, PHARMD
• James John Wallace, DO
• Jennifer F. Wallace, NP
• Jennifer Lynn Wallace
• Landon J Wallace, O.D.
• Madison Wallace
• Marisha Wallace
• Michael C Wallace, MD
• Robert D Wallace, MD
• Sharon Denice Wallace

• Metabolic Nutrition Registered Dietitian in Memphis, TN
• Providers in Memphis, TN by specialty
• Metabolic Nutrition Registered Dietitian in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.