CHERRY WALLACE NPI 1013886456

NPI Information

  • NPI: 1013886456
  • Provider Name: CHERRY WALLACE
  • Classification: Nurse Practitioner - 363LG0600X
  • Specialization: Gerontology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 425 N NEW BALLAS RD STE 203
    SAINT LOUIS, MO
    ZIP 63141
  • Phone: (314) 872-3104

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NPI Details

Cherry Wallace is a gerontology nurse practitioner in Saint Louis, MO. Cherry Wallace NPI is 1013886456. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

425 N NEW BALLAS RD STE 203
SAINT LOUIS, MO
ZIP 63141-848
Phone: (314) 872-3104

The NPI 1013886456 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/3/2025 and was last updated on 11/4/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LG0600XNurse PractitionerGerontology2025047590MISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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