Tamyra Wallace, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP135378 Issued in TX

Practice address

8189 Midtown Blvd Apt 12217
Dallas, TX 75231

Phone

(337) 201-1875

NPI assigned

Jan 5, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tamyra Wallace Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530576000000",
    "number": "1952818403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8189 MIDTOWN BLVD APT 12217",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314561",
            "telephone_number": "337-201-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8189 MIDTOWN BLVD APT 12217",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75231",
            "telephone_number": "337-201-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TAMYRA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-05",
        "last_updated": "2018-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP135378",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "AP135378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMYRA",
            "last_name": "WALLACE",
            "credential": "FNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Melissa Baker Wallace, M.D.
• Patricia Wallace
• Patrick Albert Wallace II, ATP
• Paul D Wallace, DDS
• Scott Wallace, ATP
• Terrielle Wallace
• Zachary Wallace, PHARMD
• Erin Wallach, MS CCC-SLP
• David A Waller, MD
• Diane Waller, RKT

• Family Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2018; 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.