MS. KATIE LYNN WALLACE (NPI# 1952703092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952703092 |
| Entity Type | Individual |
| Full Name | MS. KATIE LYNN WALLACE |
| Credential | FNP-BC |
| Practice Address |
140 Haverhill St Andover MA 01810-1550 |
| Mailing Address |
Po Box 760 Winchester MA 01890-4260 |
| Practice Telephone | 9784701616 |
| Practice Fax Number | 9784708165 |
| Mailing Telephone | 7817567273 |
| Mailing Fax Number | 7817210725 |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2016-03-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN2275454 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790151967 | Katie Justine Wallace | Nurse Practitioner | Mashpee Family Medicine 5 Industrial Drive, Suite 100, Mashpee, MA 02649 | 2015-08-11 |
| 1851768931 | Katie Wallace | Physical Therapist | 2918 Hawkins Dr, Searcy, AR 72143-4802 | 2015-08-25 |
| 1326260209 | Katie Etter Wallace | Physical Therapist | 597 S Enota Dr Ne, Gainesville, GA 30501-2545 | 2007-05-02 |
| Street Address |
140 HAVERHILL ST |
| City | ANDOVER |
| State | MA |
| Zip Code | 01810-1550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710985882 | Robert Peter Nelken | Pediatrics | 140 Haverhill St, Andover, MA 01810-1504 | 2005-07-12 |
| 1073022646 | Laura J Gordon | Psychologist | 140 Haverhill St, Andover, MA 01810-1550 | 2017-09-26 |
| 1104116086 | Andover Surgical Associates, LLC | Surgery | 140 Haverhill St, Andover, MA 01810-1550 | 2011-04-13 |
| 1407160435 | Katerina Angelica Mooers | Nurse Practitioner | 140 Haverhill St, Bldg 1, Andover, MA 01810-1550 | 2010-08-02 |
| 1245467794 | Jennifer C Hensley | Pediatrics | 140 Haverhill St, Andover, MA 01810-1550 | 2009-06-11 |
| 1760653679 | Winchester Physician Associates | Emergency Medicine | 140 Haverhill St, Andover, MA 01810-1550 | 2008-03-19 |
| 1700069820 | Sarah Bethany Finch | Obstetrics & Gynecology | 140 Haverhill St, Andover, MA 01810 | 2007-12-12 |
| 1215134390 | Earl R Gonzales | Surgery | 140 Haverhill St, Andover, MA 01810-1550 | 2007-07-02 |
| 1659498517 | Andover Urology Associates | Specialist | 140 Haverhill St, Doctors Park 1, Andover, MA 01810-1550 | 2007-03-24 |
| 1548393176 | Andover Pediatrics, P.C. | Pediatrics | 140 Haverhill St, Andover, MA 01810-1550 | 2007-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871123513 | Jill Katherine Priestley | Registered Nurse | 251 South Main Street, Andover, MA 01810 | 2020-01-22 |
| 1023672086 | Diane Marie Gallant | Occupational Therapy Assistant | 5606 80 Andover Street, Andover, MA 01810 | 2019-04-25 |
| 1932677473 | Jessica Howie | Physician Assistant | 28 Andover St Fl 1, Andover, MA 01810 | 2018-11-02 |
| 1972087138 | Mia Cloonan | Social Worker | 1 Punchard Avenue, Apt. 3 Rear, Andover, MA 01810 | 2018-09-23 |
| 1063995462 | Janet Suleski | Social Worker | 10 Stevens St, Andover, MA 01810 | 2018-09-11 |
| 1942794706 | Alison Catherine Lynch | Optometrist | 7 Parthenon Cir, Andover, MA 01810 | 2018-06-15 |
| 1740773647 | Wandajune Bishop-towle | Psychologist | 75 Wild Rose Dr., Andover, MA 01810 | 2018-06-14 |
| 1235689860 | Jo-ann Elizabeth Newcomb | Registered Nurse | 12 Hemlock Rd, Andover, MA 01810 | 2016-10-06 |
| 1922476712 | Marianela Rivera | Physical Therapist | 32 Osgood St., Andover, MA 01810 | 2015-09-10 |
| 1447535935 | Kathleen L Mccracken | Occupational Therapy Assistant | 200 Brickstone Square, 3rd Floor, Genesis Rehab Services, Andover, MA 01810 | 2011-10-15 |
| Find all providers in zip 01810 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386262707 | Rachel Marie Porter | Nurse Practitioner | Andover Family Medicine, 2117 N Keystone Circle, Andover, KS 67002 | 2020-07-13 |
| 1114540705 | Marie-yacinthe Nowicki | Nurse Practitioner | 29 Dascomb Rd, Andover, MA 01810-5627 | 2020-05-18 |
| 1922520360 | Christine Repsha | Nurse Practitioner | 93 Main St Apt 1, Andover, MA 01810-3883 | 2017-07-07 |
| 1245776921 | Casey Leber | Nurse Practitioner | 30 Brady Loop, Andover, MA 01810-3224 | 2017-01-18 |
| 1821131749 | Elane Dorothy Lee | Nurse Practitioner | 57 River Rd, Andover, MA 01810-1144 | 2007-02-14 |
| 1902886849 | Jana Lynn Pierce | Nurse Practitioner | 3633 Bunker Lake Blvd Nw, Andover, MN 55304-7402 | 2006-01-18 |
| 1114531258 | Jeffrey Keating | Nurse Practitioner | 68 Main St, Andover, MA 01810-3846 | 2020-09-05 |
| 1356951008 | Katherine Marciano | Nurse Practitioner | 5 Oak St, Andover, MA 01810-5824 | 2020-08-07 |
| 1922617091 | Barbara Dwumfour Davis | Nurse Practitioner | 68 Main St, Andover, MA 01810-3846 | 2020-07-24 |
| 1811544596 | Brianna Larson | Nurse Practitioner | 3633 Bunker Lake Blvd Nw, Andover, MN 55304-7402 | 2019-08-19 |
| Find all providers in ANDOVER | ||||
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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.