Kimberly Ann Wallach, NNP-BC

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

AP144855 Issued in TX

Practice address

4710 Montgomery Blvd NE
Albuquerque, NM 87109-1220

Phone

(806) 470-8876

NPI assigned

Sep 30, 2020

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

Interoperability endpoints

• Direct secure messaging: kwallach330598@ahs.direct-ci.com

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

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1881201168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3423 68TH DR",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794136121",
            "telephone_number": "806-470-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091220",
            "telephone_number": "806-470-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACH",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "NNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "TX",
            "license": "AP144855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janyce Wallace
• Jerron Wallace, LMSW
• Joshua Wallace, BS, MA
• Michael Alan Wallace, CNP
• Patricia Dianne Studerus Wallace, APRN
• Deven Waller
• McKayla Nicole Waller
• Robert Waller, MS, ATC, LAT, NASM
• Wallin & Luna Counseling Associates, LLC
• Kristin Hughes Wallin, LMFT

• Neonatal Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Neonatal Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.