Mrs Phyllis A Wallace, APRN in Konawa, OK - Medicare Nurse Practitioner

Mrs Phyllis A Wallace, APRN is a medicare enrolled "Nurse Practitioner - Family" in Konawa, Oklahoma. She went to University Of Nebraska College Of Medicine and graduated in 2003 and has 21 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Central Oklahoma Family Medical Center Inc and her current practice location is 527 W 3rd St, Konawa, Oklahoma. You can reach out to her office (for appointments etc.) via phone at (580) 925-3286.

Mrs Phyllis A Wallace is licensed to practice in Oklahoma (license number 35497) 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 1366486417.

Contact Information

	Mrs Phyllis A Wallace, APRN
	527 W 3rd St, Konawa, OK 74849-1415
	(580) 925-3286
	(580) 925-9149

Map and Direction

Provider's Profile

Full Name	Mrs Phyllis A Wallace
Gender	Female
Speciality	Nurse Practitioner
Experience	21 Years
Location	527 W 3rd St, Konawa, Oklahoma
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:

Mrs Phyllis A Wallace attended and graduated from University Of Nebraska College Of Medicine in 2003

NPI Data:

NPI Number: 1366486417
Provider Enumeration Date: 06/16/2006
Last Update Date: 11/22/2021

Medicare PECOS Information:

PECOS PAC ID: 2668511502
Enrollment ID: I20091205000121

Medical Identifiers

Medical identifiers for Mrs Phyllis A Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1366486417	NPI	-	NPPES
100155800A	Medicaid	OK
100155800B	Other	OK	SOONERCARE PROVIDER

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LW0102X	Nurse Practitioner - Women's Health	R0035497 (Oklahoma)	Secondary
363LF0000X	Nurse Practitioner - Family	35497 (Oklahoma)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Mercy Hospital Ada	Ada, OK	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Central Oklahoma Family Medical Center Inc	9931189685	49

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. Mrs Phyllis A Wallace allows following entities to bill medicare on her behalf.

Entity Name	Central Oklahoma Family Medical Center Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1831291293 PECOS PAC ID: 9931189685 Enrollment ID: O20040722001013

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. Mrs Phyllis A 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
Mrs Phyllis A Wallace, APRN 527 W 3rd St, Konawa, OK 74849-1415 Ph: (580) 925-3286	Mrs Phyllis A Wallace, APRN 527 W 3rd St, Konawa, OK 74849-1415 Ph: (580) 925-3286

Reviews and Comments

Nurse Practitioner Nurses in Konawa, OK

Michel Danette Cosby, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 527 W 3rd St, Konawa, OK 74849 Phone: 580-925-3286 Fax: 580-925-2362
Emily Nicole Davis, APRN-CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 527 W 3rd St, Konawa, OK 74849 Phone: 580-925-3286
Judy Pearce, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 527 W 3rd St, Konawa, OK 74849 Phone: 580-925-3286 Fax: 580-925-9149

Mrs Phyllis A Wallace, APRN - Medicare Nurse Practitioner in Konawa, OK