| Kimberly Lane Wallace, NP-C | |
|
3535 Pentagon Blvd, Beavercreek, OH 45431-1705 | |
| (937) 702-4000 | |
| Not Available |
| Full Name | Kimberly Lane Wallace |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Primary Care |
| Location | 3535 Pentagon Blvd, Beavercreek, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619688116 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP2300X | Nurse Practitioner - Primary Care | APRN.CNP.0032777 (Ohio) | Primary |
| Entity Name | Renal Physicians Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1962486316 PECOS PAC ID: 5193624161 Enrollment ID: O20040108000297 |
| Entity Name | Nephrology Associates Of Dayton Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1184698458 PECOS PAC ID: 1850380601 Enrollment ID: O20040507000974 |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly Lane Wallace, NP-C 935 Salem St, Brookville, OH 45309-8225 Ph: (937) 344-5173 | Kimberly Lane Wallace, NP-C 3535 Pentagon Blvd, Beavercreek, OH 45431-1705 Ph: (937) 702-4000 |
Carrie Steward, APRN-CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2605 Greenbrier Ct, Beavercreek, OH 45431 Phone: 937-782-8103 | |
Brandy L Mullett, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3535 Pentagon Blvd # 1157, Beavercreek, OH 45431 Phone: 937-702-4450 Fax: 937-702-4459 | |
Jessica Lynn Ullery, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3535 Pentagon Blvd Ste 220, Beavercreek, OH 45431 Phone: 937-429-7350 Fax: 937-431-2623 | |
Mrs. Theresa Marie Borchers, C.R.N.P. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1331 N Fairfield Rd, Beavercreek, OH 45432 Phone: 937-426-4280 | |
Ellen K Ratay, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 75 Sylvania Dr, Beavercreek, OH 45440 Phone: 937-320-5050 Fax: 937-320-5060 | |
Laura Busteed, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3535 Pentagon Blvd Ste 320, Beavercreek, OH 45431 Phone: 937-490-2270 | |
Sheryl Spires, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2510 Commons Blvd, Suite 210, Beavercreek, OH 45431 Phone: 937-429-0607 Fax: 937-558-3067 |