Caylynn Ann Wallace-Marcelle, ARNP, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

955 Issued in MN

Practice address

8441 Wayzata Blvd
Ste 140
Golden Valley, MN 55426-1366

Phone

(651) 769-6300

Fax

(651) 769-6349

NPI assigned

Dec 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Ms. Caylynn Ann Wallace Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Certified Pediatric 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.

• Bhsi, LLC

  • Clinical Psychologist
  • North Saint Paul, MN
  • NPI 1174635643
  Medicare reassignment NPD
• Hennepin County

  dba Hennepin County Mental Health Center

  • Psychiatry Physician
  • Minneapolis, MN
  • NPI 1780790345

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Hennepin County

  dba NorthPoint Health & Wellness Center - Workforce Center Medical

  • Community Health Clinic/Center
  • Minneapolis, MN
  • NPI 1154774925
  NPD
• Hennepin County

  dba Endeavors

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1962147413
  NPD
• Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Hudson, WI
  • NPI 1710129812
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1861558835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2497 7TH AVENUE E",
            "address_2": "STE 108",
            "city": "NORTH ST PAUL",
            "state": "MN",
            "postal_code": "551092946",
            "telephone_number": "651-769-6437",
            "fax_number": "651-769-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8441 WAYZATA BLVD",
            "address_2": "STE 140",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554261366",
            "telephone_number": "651-769-6300",
            "fax_number": "651-769-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-MARCELLE",
        "first_name": "CAYLYNN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "ARNP, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R180936-5",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "1809365",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861558835",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAYLYNN",
            "last_name": "WALLACE",
            "middle_name": "ANN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Madalyn Waldmann, OTRL
• Walgreen Co (Walgreens #13841)
• Walgreen Co (Walgreens #00430)
• Wendy Sue Walker, LICSW
• Krystle E Lieberman Wall, DC, RD, LD, CBS LC
• Allison Wallace, LICSW
• Mary Irene Wangechi
• Warm Hands Kind Hearts Home Care
• Lisa Marie Wassermann
• Marin Ilene Parsons Watters, DDS

• Pediatric Nurse Practitioner in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; 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.