Individual provider · Type 1 NPI
Kelly Elizabeth Wallace, NP
Nurse Practitioner · Petersburg, VA
Practice location
200 Medical Park Blvd
Petersburg, VA 23805-9274
Mailing address
2610 Setting Sun Dr
Powhatan, VA 23139-7552
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 0024183547 (VA) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1417609694
Kelly Elizabeth Wallace, NP's National Provider Identifier is 1417609694, issued on Jan 19, 2022. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Petersburg, VA. The record was last updated on Jan 27, 2022.