AMANDA GAIL WALLACE NPI 1154844041

NPI Information

  • NPI: 1154844041
  • Provider Name: AMANDA GAIL WALLACE
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 247 CIC BLVD
    WEST UNION, OH
    ZIP 45693
  • Phone: (513) 941-4999

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NPI Details

Amanda Gail Wallace is a family nurse practitioner in West Union, OH. Amanda Gail Wallace NPI is 1154844041. 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:

247 CIC BLVD
WEST UNION, OH
ZIP 45693-512
Phone: (513) 941-4999
Fax: (513) 694-0168

The NPI 1154844041 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 7/21/2017 and was last updated on 5/5/2023.

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
1363LF0000XNurse PractitionerFamily3011658KENTUCKYNo
2363LF0000XNurse PractitionerFamilyAPRN.CNP.021126OHIOYes
3163W00000XRegistered NurseRN.300987OHIONo
4163W00000XRegistered Nurse1155351KENTUCKYNo

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10241010MEDICAIDOHIO
27100477320MEDICAIDKENTUCKY

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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