Individual provider · Type 1 NPI

Kimberly Lane Wallace, NP-C

Primary Care Nurse Practitioner · Beavercreek, OH

NPI number 1619688116 Active

Practice location

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

Mailing address

935 Salem St
Brookville, OH 45309-8225

Specialties and licenses

TaxonomyCodeLicense
Primary Care Nurse Practitioner Primary 363LP2300XAPRN.CNP.0032777 (OH)

Primary Care Nurse Practitioner: Definition to come...

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About NPI 1619688116

Kimberly Lane Wallace, NP-C's National Provider Identifier is 1619688116, issued on Dec 6, 2022. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Beavercreek, OH. The record was last updated on Dec 6, 2022.