Jessica Renee Wallace, APRN-CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

021995 Issued in OH

Practice address

1821 E. High St.
Springfield, OH 45505

Phone

(937) 323-7340

Fax

(937) 323-3363

NPI assigned

Jul 4, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jessica.wallace@physurg.directbygreenway.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.

• Mercy Health Physicians Springfield Specialty Care LLC

  • Surgery Physician
  • Springfield, OH
  • NPI 1790308104

  Nurse Practitioner

  NPD (past)
• Physicians & Surgeons for Women, Inc

  • Obstetrics & Gynecology Physician
  • Springfield, OH
  • NPI 1508987629
  NPD (past)

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

{
    "created_epoch": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1871089680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 E. HIGH ST.",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45505",
            "telephone_number": "937-323-7340",
            "fax_number": "937-323-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 E. HIGH ST.",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45505",
            "telephone_number": "937-323-7340",
            "fax_number": "937-323-3363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JESSICA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "021995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Walgreen Co
• Kelly Walker
• Valerie E Walker
• Kelly Jo Wallen
• John Yolwa Walsh, RN
• Lola Walston, RD, LD
• Angela Walter, MS, ATC, LAT
• Christie L Walton, CDC-A, QMHS

• Nurse Practitioner in Springfield, OH
• Providers in Springfield, OH by specialty
• Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; 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.