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KELLIE L WALLACE-WILDING MD NPI 1063518629


NPI Information

NPI: 1063518629
Provider Name: KELLIE L WALLACE-WILDING, MD
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Organization: JACKSON CLINIC PA

PECOS Registration: Yes

Address:
2863 HIGHWAY 45 BYP
JACKSON, TN
ZIP 38305
Phone: (731) 664-1375
Get Directions

Kellie L Wallace-wilding, MD is a family medicine in Jackson, TN with 19 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Kellie L Wallace-wilding, MD NPI is 1063518629. 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:

2863 HIGHWAY 45 BYP
JACKSON, TN
ZIP 38305-618
Phone: (731) 664-1375
Fax: (731) 664-1378

The NPI 1063518629 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 following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Insertion of needle into vein for collection of blood sample (HCPCS:36415)
  • Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85025)
  • Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
  • Hemoglobin A1C level (HCPCS:83036)
  • Automated urinalysis test (HCPCS:81003)
  • Administration of pneumococcal vaccine (HCPCS:G0009)
  • Pneumococcal vaccine for injection into muscle (HCPCS:90670)
  • Injection, dexamethasone sodium phosphate, 1mg (HCPCS:J1100)
  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Routine EKG using at least 12 leads including interpretation and report (HCPCS:93000)
  • Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im (HCPCS:G0179)
  • Injection, methylprednisolone acetate, 40 mg (HCPCS:J1030)
  • Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple (HCPCS:G0180)
  • Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous (HCPCS:G0328)

The enumeration date for this NPI number is 9/14/2006 and was last updated on 11/29/2012.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine41583TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1P00634105MEDICARE PINTENNESSEE
23827516MEDICAIDTENNESSEE
33827516MEDICARE PINTENNESSEE

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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.