ASHLYN WALLACE FNP-C
NPI 1104640887
Nurse Practitioner - Family in Fairfax, VA

Q: What is Ashlyn Wallace's NPI number?

The NPI number for Ashlyn Wallace is 1104640887. It was assigned to this individual provider in the NPPES registry on November 11, 2024.

Q: What is Ashlyn Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Ashlyn Wallace was last updated on November 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 11, 2024PECOS EnrolledAccepts Medicare Assignment

8613 ROUTE 29 STE 200N, FAIRFAX, VA 22031(571) 350-8400(703) 280-9596 Get Directions Write a Review

NPPES record last updated: November 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 11, 2025, Nov 11, 2024 (2 updates tracked since 2024).

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About Ashlyn Wallace Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ASHLYN WALLACE FNP-C (NPI 1104640887) is an individual family provider in Fairfax, Virginia, licensed in Virginia (0024191724) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS and is a graduate of Georgetown University School Of Medicine (2024).

NPPES Registry Identity

NPI1104640887

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameASHLYN WALLACECredential: FNP-C

Location Address8613 ROUTE 29 STE 200NFairfax, VA 22031-2171

Mailing Address3040 Williams Dr Ste 100Fairfax, VA 22031-4618 · (571) 350-8400 · Fax (703) 280-9596

Phone(571) 350-8400

Fax(703) 280-9596

Sole ProprietorNo

Medical School CMSGeorgetown University School Of MedicineGraduated 2024

Enumeration DateNovember 11, 2024

Last NPPES UpdateNovember 11, 20252 updates tracked since enumeration

NPPES CertifiedNovember 11, 2025

✔ NPI 1104640887 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in VA · 0024191724

8613 ROUTE 29 STE 200N, Fairfax, VA 22031

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ashlyn Wallace Fnp-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1658807086

PECOS Enrollment IDI20241210000073, I20250428003290

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22031 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$100.31 typical visit price

range $65.18 – $194.86

Typical copayment $25.07 (range $16.29 – $48.71)

Most-billed visit code 99203

Established Patient

$113.72 typical visit price

range $21.40 – $158.88

Typical copayment $28.43 (range $5.35 – $39.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARA ELIZABETH MCKAY PA-C

Physician Assistant (Surgical)