Shelby Taylor Wall, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA11719 Issued in TX

Practice address

901 W Ben White Blvd
Austin, TX 78704-6903

Phone

(512) 447-2211

NPI assigned

Jan 12, 2018

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

Enrolled in TX, TN, GA3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shelby.wall@488678167609348.direct.elationemr.com

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.

• Chattanooga Emergency Medicine PLLC

  • Emergency Care Clinic/Center
  • Hixson, TN
  • NPI 1427264126
  Medicare reassignment NPD
• Pine Ridge Indian Health Service Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412

  TX

  Medicare reassignment NPD
• Longhorn Emergency Medical Associates PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1649669672
  Medicare reassignment
• Chattanooga Emergency Medicine PLLC

  • Emergency Care Clinic/Center
  • Chattanooga, TN
  • NPI 1174739908

  GA

  Medicare reassignment
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment
• Southeastern Emergency Services of Memphis, P.C.

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1164454450
  Medicare reassignment
• Southeastern Emergency Services P C

  • Nurse Practitioner
  • Athens, TN
  • NPI 1669414264
  Medicare reassignment
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515715200000",
    "number": "1861900797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SOUTH MOPAC EXPRESSWAY",
            "address_2": "APT 1521",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78746",
            "telephone_number": "765-432-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W BEN WHITE BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787046903",
            "telephone_number": "512-447-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SHELBY",
        "middle_name": "TAYLOR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-12",
        "last_updated": "2018-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Walkey, M.A., CCC-SLP
• Ashlyn Mari Wall-Gonzales, LPC
• Abraham Wall, LCSW
• Anna Elise Wall, SLP
• Jennifer N Wall, MSN, FNP-C
• William Austin Wall, LPC-A
• Kennethra Wallace Bennett
• Angella Meshelle Wallace, MS, CCC/SLP
• Bridgett D'Ann Wallace, PT
• Chelsea Renee Henderson Wallace, RN

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2018; 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.