Active NPI
Kimberly Ann Wallace, RN
- Registered Nurse
- Indianapolis, IN
National Provider Identifier
1932443546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 28178607A
- Practice address
- 1800 N Capitol Ave
E416
Indianapolis, IN 46202-1218 - Phone
- (317) 962-0097
- NPI assigned
- Nov 20, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28178607A | IN | Primary |
Addresses
Primary practice location
1800 N Capitol Ave
E416
Indianapolis, IN 46202-1218
Mailing address
1800 North Capitol Avenue
E416
Indianapolis, IN 46202
Phone (317) 962-0097
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28178607A | IN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353369600000",
"number": "1932443546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 NORTH CAPITOL AVENUE",
"address_2": "E416",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46202",
"telephone_number": "317-962-0097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 N CAPITOL AVE",
"address_2": "E416",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462021218",
"telephone_number": "317-962-0097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-20",
"last_updated": "2012-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28178607A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.