Kimberly Wallace, LPN is a
Licensed Practical Nurse based in Wampsville, New York. Kimberly Wallace is licensed to practice in New York (license number 290441) and her current practice location is
138 North Court Street, Wampsville, New York. She can be reached at her office (for appointments etc.) via phone at
(315) 366-2490.
NPI number for Kimberly Wallace is 1750785622 and her current mailing address is 2401 Clark Rd, Canastota, New York. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1750785622.
Provider's Profile
| Full Name | Kimberly Wallace |
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| Gender | Female |
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| Speciality | Licensed Practical Nurse |
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| Location | 138 North Court Street, Wampsville, New York |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1750785622
- Provider Enumeration Date: 10/21/2014
- Last Update Date: 10/21/2014
Medical Identifiers
Medical identifiers for Kimberly Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1750785622 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164W00000X | Licensed Practical Nurse | 290441 (New York) | Primary |
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. Kimberly Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kimberly Wallace, LPN
2401 Clark Rd,
Canastota, NY 13032-4759
Ph: (315) 396-8515 | Kimberly Wallace, LPN
138 North Court Street,
Wampsville, NY 13163
Ph: (315) 366-2490 |
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