KRISTIN KIRBY WALLACE (NPI# 1922303007) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922303007 |
| Entity Type | Individual |
| Full Name | KRISTIN KIRBY WALLACE |
| Credential | M.A. |
| Practice Address |
4256 Four Lakes Dr Melbourne FL 32940-1222 |
| Practice Telephone | 3217957701 |
| Mailing Telephone | 3217957701 |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2011-01-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
IMH7107 | FL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437455219 | Kristin Marie Wallace | Occupational Therapist | 2110 Washington Blvd Ste. 158, Arlington, VA 22204 | 2011-01-27 |
| 1154931129 | Kristin Wallace | Social Worker | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2020-08-05 |
| 1568749026 | Kristin Renee Wallace | Pharmacist | 3510 Evergreen Pkwy, Evergreen, CO 80439-7707 | 2011-11-11 |
| 1366745804 | Kristin Nicole Wallace | Specialist | 1506 S Oneida St, Appleton, WI 54915-1305 | 2010-12-06 |
| Street Address |
4256 FOUR LAKES DR |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-1222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003415944 | Danielle Neal | Counselor | 4173 Palladian Way, Melbourne, FL 32904-1210 | 2020-10-21 |
| 1063022317 | 21 Vets Incorporated | Counselor | 4908 Fauna Dr, Melbourne, FL 32934-7847 | 2020-08-03 |
| 1528689122 | Ichoose Change, LLC | Counselor | 1600 Malabar Rd, J-119, Melbourne, FL 32935-1408 | 2020-05-05 |
| 1588283683 | Benah Counseling LLC | Counselor | 3270 Suntree Blvd Ste 155-157, Melbourne, FL 32940-7530 | 2020-04-09 |
| 1033755376 | Tiffany Brown | Counselor | 8080 Kingswood Way, Melbourne, FL 32940-2191 | 2019-11-21 |
| 1245893403 | Adrianne Vyasulu Leonhardt | Counselor | 3230 Arden Cir, Melbourne, FL 32934-8772 | 2019-04-15 |
| 1801356480 | Neeley Renee Hughey | Counselor | 3270 Suntree Blvd Ste 121, Melbourne, FL 32940-7540 | 2019-03-21 |
| 1487135596 | Dyeanna Fuller | Counselor | 1600 W Eau Gallie Blvd Ste 201f, Melbourne, FL 32935-4149 | 2018-08-27 |
| 1811489925 | Wendy Leonard Hixon | Counselor | 1900 S Harbor City Blvd Ste 211, Melbourne, FL 32901-4760 | 2018-06-04 |
| 1639682297 | Senior Counseling Group, LLC | Counselor | 3270 Suntree Blvd Ste 2217, Melbourne, FL 32940-7558 | 2017-11-06 |
| Find all providers in MELBOURNE | ||||
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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.