DR. BROOKE MELISSA WALLS (NPI# 1205161478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205161478 |
| Entity Type | Individual |
| Full Name | DR. BROOKE MELISSA WALLS |
| Credential | DO |
| Practice Address |
1001 Noble St Tvc Fairbanks AK 99701 |
| Mailing Address |
1220 Violet Dr. Fairbanks AK 99712 |
| Practice Telephone | 9074593500 |
| Mailing Telephone | 6309918947 |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2016-12-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | FW5288293 | AK | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
FW5288293 | AK | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
FW5288293 | AK | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | UO2198 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DEA | FW5288293 | 01 |
| AK | 1631795 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124430376 | Brooke Felicia Walls | Psychiatry & Neurology | 940 W 10th St, 2416, Indianapolis, IN 46202-4807 | 2014-05-22 |
| 1851794390 | Brooke Marie Walls | Physician Assistant | 1518 Mulberry Ave, Muscatine, IA 52761-3433 | 2014-09-29 |
| Street Address |
1001 NOBLE ST TVC |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245239524 | David Kent Zetterman | Family Medicine | 1001 Noble St, Fairbanks, AK 99701-4922 | 2005-07-19 |
| 1811501679 | Professional Pharmacy LLC | Pharmacy | 1001 Noble St, Fairbanks, AK 99701-4948 | 2020-08-31 |
| 1942862149 | Jaime Nicole Sawchuk | Counselor | 1001 Noble St, Fairbanks, AK 99701-4948 | 2019-07-08 |
| 1154821593 | Shelby A Braun | Dietitian, Registered | 1001 Noble St, Fairbanks, AK 99701-4948 | 2018-02-12 |
| 1417492463 | Nancy Davidian | Registered Nurse | 1001 Noble St, Fairbanks, AK 99701-4948 | 2016-12-29 |
| 1437691771 | Katie Garrity | Dietitian, Registered | 1001 Noble St, Suite 450, Fairbanks, AK 99701-4948 | 2016-11-16 |
| 1922559558 | Tanana Valley Clinic LLC | Clinic/Center | 1001 Noble St, Fairbanks, AK 99701-4948 | 2016-10-19 |
| 1801240221 | Heather Powers | Dietitian, Registered | 1001 Noble St, Fairbanks, AK 99701-4948 | 2016-04-21 |
| 1023492642 | Jennifer Ribar | Neuromusculoskeletal Medicine & OMM | 1001 Noble St, Fairbanks, AK 99701-4948 | 2015-07-14 |
| 1013399708 | Rebekah L. Burket | Counselor | 1001 Noble St, Fairbanks, AK 99701-4948 | 2015-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659984987 | Resource Center for Parents & Children, Inc. | Social Worker | 726 26th Ave, Suite #2, Fairbanks, AK 99701 | 2020-08-26 |
| 1134738982 | Aaron Paul Sarauer | Behavior Technician | 3121 Lathrop St., Fairbanks, AK 99701 | 2020-07-28 |
| 1437715505 | Fabienne Rose Marie Siddall | Case Manager/Care Coordinator | 122 1st Avenue, Fairbanks, AK 99701 | 2019-05-14 |
| 1902461957 | Jacqueline Marie Rahm | Counselor | Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 | 2019-05-06 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1922519305 | Sarishma Sangeeta Lal | Registered Nurse | 815 2nd Ave Ste 122, Fairbanks, AK 99701 | 2017-10-12 |
| 1245690569 | Christine L Simko | Naturopath | 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 | 2016-02-29 |
| 1932581600 | Jennifer Davis | Registered Nurse | 1025 West Barnette St., Fairbanks, AK 99701 | 2015-06-18 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1578957460 | Mara Justine Becker | Physician Assistant | 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 | 2015-03-27 |
| Find all providers in zip 99701 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346211505 | Kimberly Janne Wonderlich | Dermatology | 2775 College Road, Fairbanks, AK 99709 | 2006-01-27 |
| 1396124897 | Kimberly J Wonderlich Md Faad Dermatology LLC | Dermatology | 2775 College Road, Fairbanks, AK 99709 | 2015-05-29 |
| 1699061085 | Maren Kelly Ness Gaul | Dermatology | 1001 Noble St, Fairbanks, AK 99701-4948 | 2011-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760034045 | Swiftwater Dermatology LLC | Dermatology | 209 W Katmai Ave, Soldotna, AK 99669-7409 | 2019-07-16 |
| 1932493327 | John Schultz | Dermatology | 8501 Sultana Dr, Anchorage, AK 99516-2561 | 2011-06-03 |
| 1669669867 | Layne Bedford Green | Dermatology | 5955 Zeamer Ave Ste 1, Elmendorf Afb, AK 99506-3702 | 2007-10-02 |
| 1295881977 | Gina M Brown | Dermatology | 3340 Providence Dr Ste A358, Anchorage, AK 99508-4691 | 2007-01-26 |
| 1649212937 | Michael L Cusack | Dermatology | 110 W 38th Ave Ste A2, Anchorage, AK 99503-5677 | 2006-06-12 |
| 1154363752 | Aesthetica Medical Spa LLC | Dermatology | 110 W 38th Ave, Ste A2, Anchorage, AK 99503-5650 | 2006-06-11 |
| 1114998473 | Jayne S Fortson, Md | Dermatology | 2401 E 42nd Ave, Ste 301, Anchorage, AK 99508-5205 | 2006-01-26 |
| 1467448662 | Michael D Michener | Dermatology | 3841 Piper St Ste T4-020, Anchorage, AK 99508-4673 | 2005-09-22 |
| 1821093550 | Valley Dermatology Center, Inc. | Dermatology | 851 Westpoint Dr, Ste B10, Wasilla, AK 99654-7191 | 2005-06-17 |
| 1609420215 | Anchorage Dermatology & Cosmetics, LLC | Dermatology | 615 E 82nd Ave Ste 204, Anchorage, AK 99518-3159 | 2019-07-31 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. BROOKE MELISSA WALLS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.