Provider Demographics
NPI:1427564079
Name:WALLACE, APRIL A (NP)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:A
Last Name:WALLACE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:105 W STONE DR STE 6A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3256
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:671 HIGHWAY 58 E
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-3007
Practice Address - Country:US
Practice Address - Phone:276-679-5874
Practice Address - Fax:276-679-6912
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001149129163WX0200X
VA0024175646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology