Allen Keith Wallace Jr.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1600 River Shore Dr Apt 2040
Louisville, KY 40206-1913

Phone

(901) 212-9333

NPI assigned

Feb 18, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1992398184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 RIVER SHORE DR APT 2040",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 RIVER SHORE DR APT 2040",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061913",
            "telephone_number": "901-212-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ALLEN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "QUP020M92733",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Louisville",
            "affiliation": "N",
            "address_1": "1600 River Shore Dr Apt 2040",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402061913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Todd Walker
• Betsy Wall
• Julia Elizabeth Wall, MS, OTR/L
• Wallace Therapy Inc
• Deborah Wallace-Graham, MA, BCBA, LBA
• Bennett Allan Wallace, M.S.S.W
• Carolyn Ann Wallace, LCADC
• Courtney Creal Wallace, LCSW, CADC
• Deborah I Wallace, M.D.
• Elizabeth Keller Wallace, MA, CFY-SLP

• Athletic Trainer in Louisville, KY
• Providers in Louisville, KY by specialty
• Athletic Trainer in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.