MR. WILLIAM S WALLACE (NPI# 1457334633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457334633 |
| Entity Type | Individual |
| Full Name | MR. WILLIAM S WALLACE |
| Credential | FNP |
| Practice Address |
1200 Peabody Ave Memphis TN 38104-4506 |
| Mailing Address |
Po Box 41527 Memphis TN 38174-1527 |
| Practice Telephone | 9012720003 |
| Practice Fax Number | 9012727179 |
| Mailing Telephone | 9012720003 |
| Mailing Fax Number | 9012727179 |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2010-03-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 108204 | TN | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN108204 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | TENNCARE TLC | 000000028284 | 01 |
| TN | 3388963 | 05 | |
| TN | BLUE CROSS | 4070262 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518500834 | William J Wallace Jr. | Chiropractor | 22415 Market St Apt 1406, Cornelius, NC 28031-3028 | 2019-10-18 |
| 1851740609 | William Robert Wallace | Internal Medicine | 20828 W Deer Ridge Dr, Warrenton, MO 63383-6548 | 2016-06-11 |
| 1093143745 | William Dean Wallace | Pathology | 747 W 4170 S, Murray, UT 84123-1364 | 2013-10-16 |
| 1255765194 | William Wallace | Counselor | 318 S Oak, California, MO 65018 | 2013-08-28 |
| 1598028474 | William Todd Wallace | Physical Therapist | 8225 Coyote Trl, Texarkana, TX 75503-9657 | 2012-06-16 |
| 1184842627 | William Arthur Wallace Jr. | Surgery | 1679 Eagle Harbor Pkwy, Suite C, Fleming Island, FL 32003-4815 | 2007-04-22 |
| 1013087121 | William R Wallace | Chiropractor | 139 Morristown Rd, Bernardsville, NJ 07924-2606 | 2006-11-08 |
| 1508880493 | William C Wallace | Physical Therapist | 1113 N Castle Heights Ave, Suite D, Lebanon, TN 37087-5640 | 2006-07-26 |
| 1437184017 | William H. Wallace | Legal Medicine | 1421 N State St # St.1, Ste. 504, Jackson, MS 39202-1658 | 2006-07-11 |
| 1225087562 | William E Wallace | Surgery | 2000 Ben Merritt Dr, Suite B, Decatur, TX 76234-3848 | 2006-05-06 |
| Street Address |
1200 PEABODY AVE |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-4506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811979693 | Veronica M Swannigan | Internal Medicine | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2005-11-16 |
| 1588802003 | Sharon Moore | Pharmacist | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2009-01-22 |
| 1497830194 | Ellen Buchignani | Surgery | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2006-10-25 |
| 1487637864 | David K Jennings | Internal Medicine | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2005-11-21 |
| 1942283270 | Glenn Scott Morris | Family Medicine | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2005-11-21 |
| 1427030907 | Church Health Center of Memphis Inc | Clinic/Center | 1200 Peabody Ave, Memphis, TN 38104-4506 | 2005-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730787193 | Nancy Katherine Ray | Nurse Practitioner | 4576 Poplar Ave, Memphis, TN 38117-7502 | 2020-10-16 |
| 1245837533 | Sandra Dee Garrison | Nurse Practitioner | 335 Lillian Dr, Memphis, TN 38109-4431 | 2020-10-08 |
| 1972119527 | Oneka E Poindexter | Nurse Practitioner | 86 N Rembert St, Memphis, TN 38104-2766 | 2020-09-18 |
| 1295346260 | Jimarie Nelson | Nurse Practitioner | 5100 Poplar Ave Ste 2007, Memphis, TN 38137-2007 | 2020-08-13 |
| 1346869187 | Tollaria Williams | Nurse Practitioner | 3797 Old Waverly Cv Apt 201, Memphis, TN 38125-2678 | 2020-04-12 |
| 1497388912 | Michelle Denise Jones | Nurse Practitioner | 493 Doctor M.l.k. Jr Ave, Memphis, TN 38126-3812 | 2020-02-13 |
| 1336781657 | J Wilson Health LLC | Nurse Practitioner | 5100 Poplar Ave, Fl 27 Ste 2719a, Memphis, TN 38137-2701 | 2019-10-09 |
| 1265081574 | Natalie Staten | Nurse Practitioner | 7651 Shelby Forest Cv, Memphis, TN 38125-2822 | 2019-09-09 |
| 1881247740 | Mekeilah Nevaun Johnson | Nurse Practitioner | 6005 Park Ave Ste 825b, Memphis, TN 38119-5223 | 2019-07-19 |
| 1205488087 | Wendy Powell | Nurse Practitioner | 1407 Union Ave Ste 405, Memphis, TN 38104-3627 | 2019-07-12 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.