| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ELIZABETH ANN WALLACE | 1982159356 | 2024-09-06 |
Elizabeth Wallace [F] graduated in 2016 and primarily specializes in Nurse Practitioner.
Elizabeth Ann Wallace is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1982159356. Registration indicates Elizabeth Ann Wallace is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Family, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Family, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 4486941077 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Elizabeth Ann Wallace FNP-BC |
| Other Provider Name | Elizabeth A Blair |
| Practice Office Address | 2001 LAUREL AVE STE 105 KNOXVILLE, TN US |
| Practice Office Telephone | 8655779247 |
| Practice Office Fax | 8339082095 |
| Mailing Address | 1275 DICK LONAS RD KNOXVILLE, TN 379091382 US |
| Business Telephone | 8655844747 |
| Business Fax | 8653811509 |
| Code | Practice | License No State |
|---|---|---|
| 363LF0000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Family All Other Specialties & Provider Types Nurse Practitioner Family Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 21538
TN |
| 363L00000X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner All Other Specialties & Provider Types Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers | 21538
TN |