Phyllis M Wallace (NPI# 1366486417, PAC ID# 2668511502) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1366486417 |
| PAC ID by PECOS | 2668511502 |
| Professional Enrollment ID | I20091205000121 |
| Full Name | Phyllis M Wallace |
| Organization Legal Name | CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC. |
| Address |
527 W 3rd St Konawa OK 74849-1415 |
| Phone Number | 5809253286227 |
| Gender | F |
| Medical School | UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE |
| Graduation Year | 2003 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 9931189685 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 370020 | MERCY HOSPITAL ADA |
| Address | Phone | Organization |
|---|---|---|
| 527 W 3rd St, Konawa, OK 74849-1415 | 5809253286227 | CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC. |
| Organization Legal Name | CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC. |
| Physicians | 15 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Paul Borden Tucker | Clinical Social Worker | Central Oklahoma Family Medical Center, Inc. | 1221 Arlington St B, Ada, OK 74820-4067 |
| Curtis E Harris | Endocrinology | Central Oklahoma Family Medical Center, Inc. | 1221 Arlington St, Suite B, Ada, OK 74820-4067 |
| Mika R Strong | Physician Assistant | Central Oklahoma Family Medical Center, Inc. | 905 Colony Dr, Ada, OK 74820-2329 |
| Tanya Hudson | Nurse Practitioner | Central Oklahoma Family Medical Center, Inc. | 905 Colony Dr, Ada, OK 74820-2329 |
| Kacie L Wilkin | Physician Assistant | Central Oklahoma Family Medical Center, Inc. | 905 Colony Dr, Ada, OK 74820-2329 |
| William H Chesser | Family Medicine | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| Semira Charboneau | Internal Medicine | Central Oklahoma Family Medical Center, Inc. | 905 Colony Dr, Ada, OK 74820-2329 |
| Amanda Lynn Cubit | Nurse Practitioner | Central Oklahoma Family Medical Center, Inc. | 1221 Arlington St, Suite B, Ada, OK 74820-4067 |
| Lynn D Baggett | Addiction Medicine | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| Cord Tanner Landrum | Physician Assistant | Central Oklahoma Family Medical Center, Inc. | 905 Colony Dr, Ada, OK 74820-2329 |
| Street Address |
527 W 3RD ST |
| City | KONAWA |
| State | OK |
| Zip | 74849-1415 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| William H Chesser | Family Medicine | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| Lynn D Baggett | Addiction Medicine | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| Judy L Pearce | Nurse Practitioner | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| Amanda H Lawhorn | Clinical Social Worker | Central Oklahoma Family Medical Center, Inc. | 527 W 3rd St, Konawa, OK 74849-1415 |
| City | KONAWA |
| Zip Code | 74849 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | KONAWA + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Phyllis M Wallace.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.