Provider Demographics
NPI:1760848360
Name:WALLIS, FRANKIE H
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:H
Last Name:WALLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HOWARD
Other - Middle Name:FRANKLIN
Other - Last Name:WALLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:115 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-3413
Mailing Address - Country:US
Mailing Address - Phone:256-245-3267
Mailing Address - Fax:256-245-2315
Practice Address - Street 1:115 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-3413
Practice Address - Country:US
Practice Address - Phone:256-245-3267
Practice Address - Fax:256-245-2315
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-103024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily