Alexa Nicole Wallace, MS, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2528 Issued in OK

Practice address

6160 S Yale Ave
Tulsa, OK 74136-1900

Phone

(918) 497-3140

Fax

(918) 499-3295

NPI assigned

Apr 27, 2022

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

Other names 1

• Lexi Wallace Other name

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1962146696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 1200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363333",
            "telephone_number": "918-488-6653",
            "fax_number": "918-488-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361900",
            "telephone_number": "918-497-3140",
            "fax_number": "918-499-3295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALEXA",
        "middle_name": "NICOLE",
        "credential": "MS, RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OK",
            "license": "2528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEXI",
            "last_name": "WALLACE",
            "credential": "MS, RD, LD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Yolanda J Walker, MS
• Timber Walkingstick
• Andrea S. Wall, ACNP
• Dawn Marie Wall, NP-C
• Adam Joseph Wallace, M.D.
• Alyssa Ann Wallace
• Annette S. Wallace, LPC
• Arthur G Wallace Jr., DO
• Carrie Wallace
• Christa Wallace

• Registered Dietitian in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Registered Dietitian in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.