MS. LA' TAYSIA WALLACE MSN, RN, CPNP-PC
NPI 1114297074
Nurse Practitioner - Pediatrics in Huntington Station, NY

Q: What is La' Taysia Wallace's NPI number?

The NPI number for La' Taysia Wallace is 1114297074. It was assigned to this individual provider in the NPPES registry on January 10, 2012.

Q: What is La' Taysia Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Active since January 10, 2012

21 PENNY DR, HUNTINGTON STATION, NY 11746(516) 850-9623 Get Directions Write a Review

NPPES record last updated: April 2, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 2, 2024, Jul 27, 2023, Aug 18, 2016 (3 updates tracked since 2016).

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About Ms. La' Taysia Wallace Msn, Rn, Cpnp-pc NPPES

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

MS. LA' TAYSIA WALLACE MSN, RN, CPNP-PC (NPI 1114297074) is an individual pediatrics provider in Huntington Station, New York, licensed in New York (F383676-01) and active in the NPI registry since January 2012.

NPPES Registry Identity

NPI1114297074

Entity TypeIndividualFemale

Primary Taxonomy363LP0200X

Provider Legal NameMS. LA' TAYSIA WALLACECredential: MSN, RN, CPNP-PC

Location Address21 PENNY DRHuntington Station, NY 11746-3422

Mailing AddressPo Box 3644Mount Vernon, NY 10553-3644 · (516) 850-9623

Phone(516) 850-9623

Sole ProprietorNo

Enumeration DateJanuary 10, 2012

Last NPPES UpdateApril 2, 20243 updates tracked since enumeration

NPPES CertifiedApril 2, 2024

✔ NPI 1114297074 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

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

Taxonomy Code363LP0200X

License✔ Licensed in NY · F383676-01

Also ListedRegistered NurseTaxonomy 163W00000X · License 716807-1 (NY)

Also ListedLicensed Practical NurseTaxonomy 164W00000X · License 308886-1 (NY)

21 PENNY DR, Huntington Station, NY 11746

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is La' Taysia Wallace's NPI number?

The NPI number for La' Taysia Wallace is 1114297074. It was assigned to this individual provider in the NPPES registry on January 10, 2012.

Where is La' Taysia Wallace located?

La' Taysia Wallace practices at 21 Penny Dr, Huntington Station, NY 11746. The listed phone number is (516) 850-9623.

What is La' Taysia Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

When was this NPI record last updated?

The NPPES record for La' Taysia Wallace was last updated on April 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.