Kristen Ashley Wallace, D.O.

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

License

OS023930 Issued in PA

Practice address

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Phone

(445) 242-5512

NPI assigned

May 11, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Childrens Health Care Associates, Inc

  • Neonatal-Perinatal Medicine Physician
  • Philadelphia, PA
  • NPI 1417042466
  NPD (past)
• Childrens Health Care Associates of New Jersey PC

  • Pediatrics Physician
  • Voorhees, NJ
  • NPI 1427152917
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1972039741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 ARCH ST FL 12",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191042857",
            "telephone_number": "445-242-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "445-242-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KRISTEN",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "PA",
            "license": "OS023930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Wallace, RDN
• Fiona Marcia Wallace, M.S.
• Kelly Wallace
• Kimberly Wallace, MPT
• Kimberly Wallace, PT
• Meghan Meghan Wallace
• Molly Elizabeth Wallace, MD
• Paul Wallace, M.D.
• Rasheada Lynn Wallace, (CD,PCD)
• Ruby M Wallace, RPH

• Pediatric Pulmonology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Pulmonology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.