Matthew Richard Wallace, DNP, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4044992 Issued in KY

Practice address

1000 S Limestone
Lexington, KY 40506-0007

Phone

(859) 562-7371

NPI assigned

Feb 10, 2025

Sex

Male

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 KY

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

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• University of Kentucky

  • Diagnostic Radiology Physician
  • Lexington, KY
  • NPI 1770771974
  Medicare reassignment

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

{
    "created_epoch": "1739145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1902611882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S LIMESTONE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S LIMESTONE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405060007",
            "telephone_number": "859-562-7371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 S Limestone",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405360582",
            "country_code": "US",
            "telephone_number": "859-323-2778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MATTHEW",
        "middle_name": "RICHARD",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-10",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4044992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derrick Paul Wallace
• Jerald Payden Wallace, M.D.
• Julie Bourne Wallace, M.A., CCC/SLP
• Kellie L Wallace, RN, MSN
• Madison Wallace, LPCC
• Patricia Sue Wallace, APRN
• Thomas Everett Wallace, M.D.
• William Robert Wallace, M.D.
• Joyce Anne Wallen, M.ED.
• Shawna Wallen, RPH

• Psychiatric/Mental Health Nurse Practitioner in Lexington, KY
• Providers in Lexington, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.