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LADAWNA RAE WALLACE FNP
NPI 1174478952
Nurse Practitioner - Family in Show Low, AZ

Active since February 26, 2026PECOS EnrolledAccepts Medicare Assignment
4951 S WHITE MOUNTAIN RD BLDG A, SHOW LOW, AZ 85901(928) 532-3926(928) 532-2159 Get Directions Write a Review

NPPES record last updated: June 2, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ladawna Rae Wallace Fnp NPPES

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

LADAWNA RAE WALLACE FNP (NPI 1174478952) is an individual family provider in Show Low, Arizona, licensed in Arizona (227454) and active in the NPI registry since February 2026. She is enrolled in Medicare PECOS, maintains a secondary practice location in Show Low, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1174478952
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameLADAWNA RAE WALLACECredential: FNP
Location Address4951 S WHITE MOUNTAIN RD BLDG AShow Low, AZ 85901-7827
Mailing Address4951 S White Mountain Rd Bldg AShow Low, AZ 85901-7827 · (928) 532-3926 · Fax (928) 532-2159
Phone(928) 532-3926
Fax(928) 532-2159
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateFebruary 26, 2026
Last NPPES UpdateJune 2, 2026
NPPES CertifiedJune 2, 2026
✔ NPI 1174478952 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 AZ · 227454
4951 S WHITE MOUNTAIN RD BLDG A, Show Low, AZ 85901
Open in Google Maps ↗

Secondary Practice Location 1

Location 12051 Evergreen LnShow Low, AZ 85901-7928 · Phone (928) 457-1200

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

Ladawna Rae Wallace Fnp 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 ID446728067
PECOS Enrollment IDI20260501001612
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 85901 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
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
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 20

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

MR. CURTIS VANCE BIRDNO PA-C
Physician Assistant (Medical)
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 532-1605
RAELYNN M. MUSICK N.P.
Nurse Practitioner (Family)
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
QUEZIA HALL PA
Physician Assistant
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
KATHERYN M JOHNSTON FNP-C
Nurse Practitioner (Family)
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
CONSTANCE L COLLMAN FNP
Nurse Practitioner (Family)
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
RYAN VARGA D.O.
Family Medicine
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
JARED AARON HALL DPM
Podiatrist (Foot & Ankle Surgery)
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700
DR. GEOFFREY IAN BOYER DO
Surgery
4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW, AZ 85901
Navajo County (928) 537-6700

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 Ladawna Wallace's NPI number?

The NPI number for Ladawna Wallace is 1174478952. It was assigned to this individual provider in the NPPES registry on February 26, 2026.

Where is Ladawna Wallace located?

Ladawna Wallace practices at 4951 S White Mountain Rd Bldg A, Show Low, AZ 85901. The listed phone number is (928) 532-3926.

What is Ladawna Wallace's specialty?

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

Is Ladawna Wallace enrolled in Medicare?

Yes. Ladawna Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Ladawna Wallace was last updated on June 2, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.