TYLER J WALLACE PMHNP-BC
NPI 1114700739
Nurse Practitioner - Psychiatric/Mental Health in Paducah, KY

Q: What is Tyler Wallace's NPI number?

The NPI number for Tyler Wallace is 1114700739. It was assigned to this individual provider in the NPPES registry on August 16, 2023.

Q: What is Tyler Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Tyler Wallace was last updated on November 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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 August 16, 2023PECOS EnrolledAccepts Medicare Assignment

1532 LONE OAK RD STE 345, PADUCAH, KY 42003(270) 444-2250(270) 538-6596 Get Directions Write a Review

NPPES record last updated: November 14, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 14, 2024, Aug 16, 2023 (2 updates tracked since 2023).

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About Tyler J Wallace Pmhnp-bc NPPES

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

TYLER J WALLACE PMHNP-BC (NPI 1114700739) is an individual psychiatric/mental health provider in Paducah, Kentucky, licensed in Kentucky (4005513) and active in the NPI registry since August 2023. He is enrolled in Medicare PECOS, is affiliated with Mercy Health - Lourdes Hospital, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1114700739

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NameTYLER J WALLACECredential: PMHNP-BC

Location Address1532 LONE OAK RD STE 345Paducah, KY 42003-7942

Mailing Address1532 Lone Oak Rd Ste 345Paducah, KY 42003-7942 · (270) 444-2250

Phone(270) 444-2250

Fax(270) 538-6596

Sole ProprietorYes

Medical School CMSOtherGraduated 2023

Enumeration DateAugust 16, 2023

Last NPPES UpdateNovember 14, 20242 updates tracked since enumeration

NPPES CertifiedNovember 14, 2024

✔ NPI 1114700739 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in KY · 4005513

1532 LONE OAK RD STE 345, Paducah, KY 42003

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Ohio, Inc..Insurance ›

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

Tyler J Wallace Pmhnp-bc 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 ID4981130986

PECOS Enrollment IDI20241213003096

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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Health - Lourdes Hospital

Acute Care Hospitals · Paducah, KY

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number180102

Location1530 Lone Oak RoadPaducah, KY 42003 · Mc Cracken County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 42003 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

$82.24 typical visit price

range $52.76 – $162.27

Typical copayment $20.56 (range $13.19 – $40.56)

Most-billed visit code 99203

Established Patient

$93.94 typical visit price

range $16.53 – $131.99

Typical copayment $23.48 (range $4.13 – $32.99)

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 7

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

PORTIA LYNN DAVIS LPCC

Counselor (Professional)