MR. BENJAMIN LEVI WALLACE (NPI# 1962913293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962913293 |
| Entity Type | Individual |
| Full Name | MR. BENJAMIN LEVI WALLACE |
| Credential | FNP-C |
| Practice Address |
264 Fm 3478 Rd Huntsville TX 77320-3322 |
| Mailing Address |
540 Pine St Crockett TX 75835-5555 |
| Practice Telephone | 9362914200 |
| Mailing Telephone | 9362221358 |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2017-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP134640 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033647516 | Benjamin Wallace | Dentist | 517 N Stone Rd, Fremont, MI 49412-9620 | 2017-05-30 |
| 1467883108 | Benjamin Wallace | Emergency Medicine | 376 W 10th Ave, 776 Prior Hall, Columbus, OH 43210-1280 | 2013-12-05 |
| 1992936066 | Benjamin P Wallace | Physician Assistant | 3600 Nw Samaritan Drive, Suite 227, Corvallis, OR 97330-3737 | 2009-08-06 |
| Street Address |
264 FM 3478 RD |
| City | HUNTSVILLE |
| State | TX |
| Zip Code | 77320-3322 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043280118 | David Lee Seals | Dentist | 264 Fm 3478 Rd, Huntsville, TX 77320-3322 | 2006-01-23 |
| 1104337419 | Chidinma Onuigbo | Nurse Practitioner | 264 Fm 3478 Rd, Huntsville, TX 77320-3322 | 2017-10-13 |
| 1447784574 | Tanesha Sorkpor | Registered Nurse | 264 Fm 3478 Rd, Huntsville, TX 77320-3322 | 2017-04-15 |
| 1588025415 | Olufunmilayo Victoria Adefolarin | Nurse Practitioner | 264 Fm 3478 Rd, Huntsville, TX 77320-3322 | 2016-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902442056 | Lone Star Community Health Center, Inc. | Clinic/Center | 227 Sh 75n Ste. 130, Huntsville, TX 77320 | 2019-11-25 |
| 1811546237 | Jennifer Congdon | Nurse Practitioner | 264 Fm 3478, Huntsville, TX 77320 | 2019-09-09 |
| 1164900379 | Melissa Sanders-devillier | Counselor | 107 W. Main St., Trinity, TX 77320 | 2018-07-31 |
| 1972050946 | Futuristikidz Residential Facility | Clinic/Center | 683 Fm 980rd., Huntsville, TX 77320 | 2016-09-07 |
| 1033583588 | Jacquelyn Elaine Shair | Counselor | 2521 Crosstimbers, Apt B-1, Huntsville, TX 77320 | 2015-11-20 |
| 1134526155 | Donna Marie Brinegar | Specialist/Technologist | 112 Magnolia Way, Huntsville, TX 77320 | 2014-11-20 |
| 1922338466 | 2t Enterprises Medpro Ems | Ambulance | 1425 Highway 75 North, Huntsville, TX 77320 | 2010-01-06 |
| 1346495884 | Rose Anna Renee Lerma | Massage Therapist | 101 Enfield Court, Huntsville, TX 77320 | 2008-11-25 |
| 1720298193 | Doris L Marshall | Custodial Care Facility | 21 Archie Rd, Huntsville, TX 77320 | 2007-05-23 |
| 1417171075 | Medpro Medical Services Inc | Ambulance | 1425 Hwy 75 N, Huntsville, TX 77320 | 2007-04-12 |
| Find all providers in zip 77320 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174320 | Sweet Home Telehealth LLC | Nurse Practitioner | 3 Sudworth Dr Sw, Huntsville, AL 35824-4099 | 2020-11-07 |
| 1386251742 | Jennifer Lynn Castillo | Nurse Practitioner | 280 S 9500 E, Huntsville, UT 84317-9766 | 2020-09-29 |
| 1306452545 | Richard Keith Fell | Nurse Practitioner | 2785 Carl T Jones Dr Se Ste C, Huntsville, AL 35802-4947 | 2020-09-22 |
| 1003422742 | Elena Mihaela Kruse | Nurse Practitioner | 415 Echurch St, Nw Suite 4, Huntsville, AL 35801 | 2020-09-18 |
| 1881211647 | Ciara Whitt | Nurse Practitioner | 26 Maple Grove Blvd Sw, Huntsville, AL 35824-4005 | 2020-06-28 |
| 1275158289 | Lynda Jean Masco | Nurse Practitioner | 807 Tannahill Dr Se, Huntsville, AL 35802-1935 | 2020-06-15 |
| 1265068076 | Sarah Jean | Nurse Practitioner | 1610 Ben Graves Drive Nw, Huntsville, AL 35816 | 2020-03-13 |
| 1497387229 | Mary Anne Tessitore | Nurse Practitioner | 193 Interstate 45 S, Huntsville, TX 77340-4256 | 2020-02-10 |
| 1790324424 | Ashley Froscello I | Nurse Practitioner | 610 Airport Rd Sw # 210, Huntsville, AL 35802-4304 | 2019-12-28 |
| 1811546237 | Jennifer Congdon | Nurse Practitioner | 264 Fm 3478, Huntsville, TX 77320 | 2019-09-09 |
| Find all providers in HUNTSVILLE | ||||
| City | HUNTSVILLE |
| Zip Code | 77320 |
Please comment or provide details below to improve the information on MR. BENJAMIN LEVI 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.