KYLE WALLACE NPI 1205258258

NPI Information

NPI: 1205258258
Provider Name: KYLE WALLACE
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
20870 GRAND CENTRAL PKWY APT 3G
QUEENS VILLAGE, NY
ZIP 11427
Phone: (646) 533-2645
Get Directions

Kyle Wallace is an adult health nurse practitioner in Queens Village, NY with 2 years of experience. Kyle Wallace NPI is 1205258258. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

20870 GRAND CENTRAL PKWY APT 3G
QUEENS VILLAGE, NY
ZIP 11427-559
Phone: (646) 533-2645

The NPI 1205258258 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/10/2014 and was last updated on 7/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		546269-1	NEW YORK	No
2	363LA2200X	Nurse Practitioner	Adult Health	F311097-01	NEW YORK	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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