JAILENE WALLACE FNP-C NPI 1891678702

NPI Information

  • NPI: 1891678702
  • Provider Name: JAILENE WALLACE, FNP-C
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 712 BROAD ST
    PROVIDENCE, RI
    ZIP 02907
  • Phone: (401) 233-5060

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NPI Details

Jailene Wallace, FNP-C is a family nurse practitioner in Providence, RI. Jailene Wallace, FNP-C NPI is 1891678702. 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:

712 BROAD ST
PROVIDENCE, RI
ZIP 02907-465
Phone: (401) 233-5060

The NPI 1891678702 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 7/29/2025 and was last updated on 9/15/2025.

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
1363LF0000XNurse PractitionerFamilyAPRN04646RHODE ISLANDYes
2207QG0300XFamily MedicineGeriatric MedicineAPRN04646RHODE ISLANDNo

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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