MRS. KARLA MARIE WALLACE (NPI# 1740757145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740757145 |
| Entity Type | Individual |
| Full Name | MRS. KARLA MARIE WALLACE |
| Credential | FNP-C |
| Practice Address |
314 Main St Ste B Monticello MS 39654-3702 |
| Practice Telephone | 6015874304 |
| Mailing Telephone | 6015874304 |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2019-04-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
902985 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2824 Dena Ln Sw, Bogue Chitto, MS 396296000 | 6013202096 |
| Street Address |
314 MAIN ST STE B |
| City | MONTICELLO |
| State | MS |
| Zip Code | 39654-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952949182 | Brandy Wilson | Nurse Practitioner | 314 Main St Ste B, Monticello, MS 39654-3702 | 2019-12-18 |
| 1861959256 | Caring Hands Family Practice, LLC | Nurse Practitioner | 314 Main St Ste B, Monticello, MS 39654-3702 | 2019-02-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013558824 | Downhome Pharmacy, Inc. | Pharmacy | 606 W. Broad St, Monticello, MS 39654 | 2019-10-02 |
| 1700344066 | Southwest Mississippi Regional Medical Center | Surgery | 1065 E Broad St., Monticello, MS 39654 | 2019-03-06 |
| 1457862229 | Susan Nevels | Pharmacist | 1509 Highway 84 West, Monticello, MS 39654 | 2017-10-19 |
| 1326565417 | David Warren Ready | Pharmacist | 1509 Hwy 84 West, Monticello, MS 39654 | 2017-08-29 |
| 1861664575 | James Mikel Griffith II | Physical Therapy Assistant | 314 Main St, Ste C, Monticello, MS 39654 | 2008-04-02 |
| 1811169840 | Southwest Mississippi Planning and Development District | Clinic/Center | 1477 Fe Sellers Highway, Monticello, MS 39654 | 2008-03-31 |
| 1447429089 | Foot and Wound Institute of The South | Clinic/Center | 157 Fe Sellers Highway, Monticello, MS 39654 | 2008-02-28 |
| 1346431566 | Amy Eaton Broome | Physical Therapy Assistant | 314 Main St Ste C, Monticello, MS 39654 | 2007-08-05 |
| 1881804532 | Chris Gilbert Boyd | Dentist | 716 Brookhaven Street, Monticello, MS 39654 | 2007-05-23 |
| 1851463707 | Brantley B. Pace | Family Medicine | 713 Watts St., Monticello, MS 39654 | 2006-11-15 |
| Find all providers in zip 39654 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457968406 | Sojnia Irene Johnson | Nurse Practitioner | 561 Country Oaks Ln, Monticello, KY 42633-5145 | 2020-09-24 |
| 1023622081 | Marty Kyle Ballard Sr. | Nurse Practitioner | 698 Lower Brookhaven Rd, Monticello, MS 39654-9627 | 2020-09-06 |
| 1659918936 | Shelby Mcmickle | Nurse Practitioner | 170 Brixie Rd, Monticello, AR 71655-9096 | 2019-12-05 |
| 1104462712 | Ashley Leanna Huitt | Nurse Practitioner | Drew Memorial Health System, 778 Scogin Drive, Monticello, AR 71655 | 2019-11-19 |
| 1053964965 | Faith Healthcare Inc | Nurse Practitioner | 126 Franklin Drive, Monticello, KY 42633 | 2019-07-19 |
| 1770039752 | Jesse Bone | Nurse Practitioner | 766 Hl Ross Drive, Monticello, AR 71655 | 2016-08-30 |
| 1295196137 | Miranda Tompkins | Nurse Practitioner | 1215 N Main St Ste 2, Monticello, KY 42633-2900 | 2016-03-18 |
| 1285065292 | Teresa Conerly | Nurse Practitioner | 430 W Broad St, Monticello, MS 39654-7723 | 2013-12-02 |
| 1487089546 | Doretha Bournes | Nurse Practitioner | 354 Cub Brown Rd, Monticello, MS 39654-7505 | 2013-09-09 |
| 1881875458 | Family Nurse Prctitioner Health Assoc,pc | Nurse Practitioner | 10 Prince Street, Suite 7, Monticello, NY 12701 | 2007-11-23 |
| Find all providers in MONTICELLO | ||||
| City | MONTICELLO |
| Zip Code | 39654 |
Please comment or provide details below to improve the information on MRS. KARLA MARIE 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.