STACY L WALLACE (NPI# 1487896668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487896668 |
| Entity Type | Individual |
| Full Name | STACY L WALLACE |
| Credential | RD |
| Practice Address |
20330 Huebner Rd Suite 104 San Antonio TX 78258-3508 |
| Mailing Address |
11321 Fallbrook Dr Houston TX 77065-4232 |
| Practice Telephone | 8322373500 |
| Practice Fax Number | 8322370200 |
| Mailing Telephone | 8322373500 |
| Mailing Fax Number | 8322370200 |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
855077 | TX | Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386264109 | Stacy Wallace | Driver | 324 Kenilworth Ave, Toledo, OH 43610-1456 | 2020-04-22 |
| 1588131866 | Stacy Ann Wallace | Naturopath | 3976 East Harbor Road, Langley, WA 98260 | 2018-10-25 |
| 1952876641 | Stacy Rose Wallace | Chore Provider | 6725 S Eastern Ave, Las Vegas, NV 89119-3948 | 2018-10-09 |
| 1003249848 | Stacy Lea Wallace | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2013-08-15 |
| 1205843422 | Stacy Wallace | Nurse Practitioner | 1702 N Alamo St, Suite 220, San Antonio, TX 78215-1201 | 2006-08-01 |
| Street Address |
20330 HUEBNER RD SUITE 104 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78258-3508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871964171 | Diabetes America | Dietitian, Registered | 20330 Huebner Rd, San Antonio, TX 78258-3508 | 2015-10-13 |
| 1003168790 | Jennifer Duggins | Physical Therapist | 20330 Huebner Rd, Ste 102, San Antonio, TX 78258-3509 | 2012-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356980163 | Jeffrey M. Martinez, M.d., P.a. | Surgery | 525 Centre Oak Drive, Suite 140, San Antonio, TX 78258 | 2019-12-26 |
| 1588226211 | New Life Brace and Limb, LLC | Prosthetist | 300 E. Sonterra Blvd., Suite 220, San Antonio, TX 78258 | 2019-07-02 |
| 1720649080 | Miguel Ibarra | Pharmacist | 18866 Stone Oak Pkwy., St.101, San Antonio, TX 78258 | 2019-06-26 |
| 1528538113 | Kevin Scott Farnsworth | Dentist | 1130 E. Sonterra Blvd Suite 100, San Antonio, TX 78258 | 2018-11-27 |
| 1891262176 | Dentists of Stone Oak, PC | Dentist | 23714 Hardy Oak Blvd, Suite 110, San Antonio, TX 78258 | 2018-10-25 |
| 1003399437 | Jesus Alcala | Physical Therapist | 20821 Us Hwy 281 N, Ste 110, San Antonio, TX 78258 | 2018-09-11 |
| 1184106544 | Marissa Kaye Bruton | Occupational Therapist | 505 Madison Oak, San Antonio, TX 78258 | 2018-09-02 |
| 1508346933 | Desiree Carroll | Occupational Therapy Assistant | 18803 Hardy Oak Drive, San Antonio, TX 78258 | 2018-08-15 |
| 1700376456 | Conner Jay Mcnabb | Optometrist | 810 Knights Cross Dr Ste 101, San Antonio, TX 78258 | 2018-05-17 |
| 1982191516 | Freehand Solutions LLC | Chiropractor | Nec Stone Oak Parkway & Loop 1604, San Antonio, TX 78258 | 2018-04-19 |
| Find all providers in zip 78258 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700252848 | Tatjana Walker | Dietitian, Registered | 264 W Mariposa Dr, San Antonio, TX 78212-1507 | 2015-08-12 |
| 1427430065 | Nora Elia Moreno | Dietitian, Registered | 5107 Medical Dr, San Antonio, TX 78229 | 2015-06-19 |
| 1114162153 | Bethany L Zimbicki | Dietitian, Registered | 7863 Callaghan Rd, Suite 206, San Antonio, TX 78229-2453 | 2008-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909202 | Kevin Connolly Klatt | Dietitian, Registered | 4607 Morningside Dr, Houston, TX 77005-1441 | 2020-10-09 |
| 1346758745 | Jacqueline Kay Williams | Dietitian, Registered | 15008 Sendero Ln, Waco, TX 76712-7570 | 2018-01-19 |
| 1760879530 | Erica Hefner | Dietitian, Registered | 3117 Sharpview Ln, Dallas, TX 75228-6057 | 2015-04-20 |
| 1801226634 | Maynon Michelle Ballow | Dietitian, Registered | 4209 Mckinney Avenue Suite 202-c, Dallas, TX 75207 | 2013-11-14 |
| 1831432004 | Cindy M Rose | Dietitian, Registered | 1617 Arbor Crest Dr Apt 1822, Bedford, TX 76021-1816 | 2013-04-05 |
| 1710233630 | Kalyani Alladi | Dietitian, Registered | 15173 Regal Oak Ln, Frisco, TX 75035-6444 | 2012-07-29 |
| 1164794301 | Leanne Skinner | Dietitian, Registered | 4127 Honeycomb Rock Circle, Austin, TX 78731 | 2012-02-03 |
| 1780903559 | Therese Lebeau | Dietitian, Registered | 2212 Dunlavy St Apt 3, Houston, TX 77006-1749 | 2010-05-19 |
| 1265769053 | Beverly Millison | Dietitian, Registered | 3701 Lavorton Pl, Flower Mound, TX 75022-6708 | 2009-11-16 |
| 1306088349 | Emily Lepow | Dietitian, Registered | 2495 S. Braeswood, Houston, TX 77030-4332 | 2009-04-06 |
| Find all providers with the same taxonomy | ||||
| City | SAN ANTONIO |
| Zip Code | 78258 |
Please comment or provide details below to improve the information on STACY L WALLACE.
| 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.