Active NPI
Alexis D Wallace, CPSS
- Peer Specialist
- Somerset, KY
National Provider Identifier
1912688797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1207173
- Practice address
- 80 Highway 2227
Somerset, KY 42503-1562 - Phone
- (606) 485-4003
- NPI assigned
- Jul 26, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 296874 | KY | |
| Peer Specialist | 175T00000X | 1207173 | KY | Primary |
Addresses
Primary practice location
80 Highway 2227
Somerset, KY 42503-1562
Mailing address
80 Highway 2227
Somerset, KY 42503-1562
Phone (606) 485-4003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 296874 | KY | MD | Addiction (Substance Use Disorder) Counselor |
| 1207173 | KY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737331200000",
"number": "1912688797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 HIGHWAY 2227",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425031562",
"telephone_number": "606-485-4003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 HIGHWAY 2227",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425031562",
"telephone_number": "606-485-4003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ALEXIS",
"middle_name": "D",
"credential": "CPSS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-26",
"last_updated": "2025-01-20",
"certification_date": "2025-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "KY",
"license": "296874",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "KY",
"license": "1207173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerset, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.