MRS. SHERITA DANIELLE WALLACE (NPI# 1225502412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225502412 |
| Entity Type | Individual |
| Full Name | MRS. SHERITA DANIELLE WALLACE |
| Other Name | MS. SHERITA DANIELLE BOYD |
| Credential | NP |
| Practice Address |
1120 E Main St Ste 24 Philadelphia MS 39350 |
| Mailing Address |
1120 E Main St Ste 24 Philadelphia MS 39350-2300 |
| Practice Telephone | 6017818677 |
| Practice Fax Number | 6016760550 |
| Mailing Telephone | 6017818677 |
| Mailing Fax Number | 6016760550 |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2019-09-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
902938 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00786527 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1331 Old Oak Pl., Montgomery, AL 36117 | 3344099242 | |
| 1120 E Main St Ste 24, Philadelphia, MS 393502300 | 6017818677 | 6016760550 |
| Street Address |
1120 E MAIN ST STE 24 |
| City | PHILADELPHIA |
| State | MS |
| Zip Code | 39350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952548646 | Kathy Gray | Counselor | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2009-01-16 |
| 1881202182 | Tawana Gipson | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2020-07-22 |
| 1790303816 | Comanechi Clayton | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2020-07-07 |
| 1326687344 | Lakeeia Lashoundra Myles | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2019-12-23 |
| 1275170300 | Aislin Boler | Counselor | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2019-12-09 |
| 1679120190 | Skye Carlisle | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2019-08-20 |
| 1760963805 | Leah Rigney | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2018-08-27 |
| 1245717685 | Intouch Health | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2018-07-27 |
| 1588171128 | Stephanie Edwards | Nurse Practitioner | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2018-01-04 |
| 1932610623 | Lowell Wallace | Social Worker | 1120 E Main St Ste 24, Philadelphia, MS 39350-2300 | 2017-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548817133 | Airpark Family Dentistry | Dentist | 1060 Holland Avenue, Philadelphia, MS 39350 | 2019-08-20 |
| 1396303962 | Medical Foundation Inc | Obstetrics & Gynecology | Rush Medical Group / Philadelphia, 1106 Central Drive, Ste 3, Philadelphia, MS 39350 | 2019-05-30 |
| 1144759580 | Mapp Home Care Services | In Home Supportive Care | 41 Eastover Dr, Philadelphia, MS 39350 | 2017-06-08 |
| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| 1114339405 | Bernard Oneal | Adult Companion | 10090 Rd 0022, None, Philadelphia, MS 39350 | 2014-05-21 |
| 1417213323 | Region Ten Commision On Mental Health | Clinic/Center | 1011 Posey Avenue, Philadelphia, MS 39350 | 2012-04-04 |
| 1851427132 | Performance Therapy LLC | Physical Therapist | Performance Therapy, LLC, 921 W Beacon Street, Philadelphia, MS 39350 | 2007-02-23 |
| 1922161900 | Ernest Barton Cross | Audiologist | 1120 East Main Street, Suite 4, Philadelphia, MS 39350 | 2006-12-19 |
| 1649348129 | Augustus P Soriano | Family Medicine | 517 Center Avenue, Philadelphia, MS 39350 | 2006-12-01 |
| 1982777983 | Bill G Molpus | Dentist | 247 Byrd Ave, Philadelphia, MS 39350 | 2006-11-16 |
| Find all providers in zip 39350 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199341 | Nicole Kassandra Carissimi | Nurse Practitioner | 1618 S 19th St, Philadelphia, PA 19145-1439 | 2020-09-19 |
| 1770192775 | Lisa Ghiloni | Nurse Practitioner | 6809 N 10th St, Philadelphia, PA 19126-2906 | 2020-07-26 |
| 1104440940 | Patricia Cecilia Castillo | Nurse Practitioner | 49204 Delaire Landing Rd, Philadelphia, PA 19114-5329 | 2020-06-06 |
| 1184271074 | Clement John | Nurse Practitioner | 3253 N 6th St, Philadelphia, PA 19140-5644 | 2019-08-25 |
| 1558915967 | Latoya Mohammed | Nurse Practitioner | 3300 Henry Ave Ste 3n, Philadelphia, PA 19129-1141 | 2019-07-25 |
| 1225427867 | Alison Ercole | Nurse Practitioner | 4301 Spruce St, Apt A 414, Philadelphia, PA 19104-4760 | 2015-01-20 |
| 1790195386 | Thomasean Britten | Nurse Practitioner | 449 Parker Ave, Philadelphia, PA 19128-4403 | 2014-05-05 |
| 1891048377 | Elizabeth Ann Milburn | Nurse Practitioner | 1528 Walnut St Ste 1414, Philadelphia, PA 19102-3610 | 2012-10-20 |
| 1336410851 | Justin Egoville | Nurse Practitioner | 80001 State Rd., Mhm Correctional Services, Mod II, Philadelphia, PA 19136-0000 | 2012-01-13 |
| 1396050720 | Dwayne M Toomer | Nurse Practitioner | 718 Addison St Apt E, Philadelphia, PA 19147-1353 | 2010-08-10 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 39350 |
Please comment or provide details below to improve the information on MRS. SHERITA DANIELLE WALLACE.
| 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.