Individual provider · Type 1 NPI
Cherry Wallace, FNP
Gerontology Nurse Practitioner · St. Louis, MO
NPI number
1013886456
Active
Practice location
425 N New Ballas Rd Ste 203
St. Louis, MO 63141-6848
Mailing address
905 Chestnut Ridge Rd
Manchester, MO 63021-6925
Other practice locations
- 3009 N Ballas Rd Ste 100B, St. Louis, MO 63131-2322 · (314) 432-1111
- 1400 Lemay Ferry Rd, St. Louis, MO 63125-2408 · (314) 685-8721
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner Primary | 363LG0600X | 2025047590 (MO) |
Gerontology Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1013886456
Cherry Wallace, FNP's National Provider Identifier is 1013886456, issued on Nov 3, 2025. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in St. Louis, MO. The record was last updated on Aug 19, 2026.