Kelly Elizabeth Wallace, NP in Petersburg, VA

Kelly Elizabeth Wallace, NP is a medicare enrolled "Nurse Practitioner" in Petersburg, Virginia. She graduated from nursing school in 2021 and has 4 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Alexandria Springfield Emergency Physicians Pc, Cep America Llc and her current practice location is 200 Medical Park Blvd, Petersburg, Virginia. You can reach out to her office (for appointments etc.) via phone at (804) 765-5000.

Kelly Elizabeth Wallace is licensed to practice in Virginia (license number 0024183547) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1417609694.

Contact Information

	Kelly Elizabeth Wallace, NP
	200 Medical Park Blvd, Petersburg, VA 23805-9274
	(804) 765-5000
	Not Available

Map and Direction

Provider's Profile

Full Name	Kelly Elizabeth Wallace
Gender	Female
Speciality	Nurse Practitioner
Experience	4 Years
Location	200 Medical Park Blvd, Petersburg, Virginia
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Kelly Elizabeth Wallace graduated from nursing school in 2021

NPI Data:

NPI Number: 1417609694
Provider Enumeration Date: 01/19/2022
Last Update Date: 01/27/2022

Medicare PECOS Information:

PECOS PAC ID: 9537552286
Enrollment ID: I20220202001007

Medical Identifiers

Medical identifiers for Kelly Elizabeth Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1417609694	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	0024183547 (Virginia)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Alexandria Springfield Emergency Physicians Pc	1052558954	42
Cep America Llc	6608056171	569

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Elizabeth Wallace allows following entities to bill medicare on her behalf.

Entity Name	Emergency Medicine Associates Pa Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1134117393 PECOS PAC ID: 8022914522 Enrollment ID: O20031208000283

Entity Name	Alexandria Springfield Emergency Physicians Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1740529700 PECOS PAC ID: 1052558954 Enrollment ID: O20200115002186

Entity Name	Cep America Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1629722129 PECOS PAC ID: 6608056171 Enrollment ID: O20220506001288

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Elizabeth Wallace is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kelly Elizabeth Wallace, NP 2610 Setting Sun Dr, Powhatan, VA 23139-7552 Ph: (910) 443-1679	Kelly Elizabeth Wallace, NP 200 Medical Park Blvd, Petersburg, VA 23805-9274 Ph: (804) 765-5000

Reviews and Comments

Nurse Practitioner Nurses in Petersburg, VA

Ms. Nancy Joyner Gauldin, CNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 301 Halifax St, Petersburg, VA 23803 Phone: 804-863-1652 Fax: 804-862-6126
Olivia Mendoza, NP Nurse Practitioner Medicare: May Accept Medicare Assignments Practice Location: 269 Medical Park Blvd, Petersburg, VA 23805 Phone: 804-861-0700
Linda P. Whiteley, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 301 Halifax St, Petersburg, VA 23803 Phone: 804-862-1652
Jocelyn L Burls, NP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 321c Poplar Dr, Petersburg, VA 23805 Phone: 804-733-5591
Chiquita Michone Thomas-jackson, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3916 S Crater Rd, Petersburg, VA 23805 Phone: 804-526-4300
Ms. Erica Lynn Bagby, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 321c Poplar Dr, Petersburg, VA 23805 Phone: 804-733-5591 Fax: 804-733-3506
Ms. Evelyn Maria Cason, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 849 S Sycamore St Ste A, Petersburg, VA 23803 Phone: 804-715-1031 Fax: 804-203-4722

Kelly Elizabeth Wallace, NP - Medicare Nurse Practitioner in Petersburg, VA