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KESHAWN LATRELL WALLACE
NPI 1194532911
Student in an Organized Health Care Education/Training Program in Tulsa, OK

Active since December 16, 2024
1111 W 17TH ST, TULSA, OK 74107(918) 582-1972 Get Directions Write a Review

NPPES record last updated: December 16, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Keshawn Latrell Wallace NPPES

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

KESHAWN LATRELL WALLACE (NPI 1194532911) is an individual student in an organized health care education/training program in Tulsa, Oklahoma and active in the NPI registry since December 2024.

NPPES Registry Identity

NPI1194532911
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKESHAWN LATRELL WALLACE
Location Address1111 W 17TH STTulsa, OK 74107-1886
Mailing Address1933 S Independence StSapulpa, OK 74066-6201 · (903) 495-9683
Phone(918) 582-1972
Sole ProprietorYes
Enumeration DateDecember 16, 2024
NPPES CertifiedDecember 15, 2024
✔ NPI 1194532911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1111 W 17TH ST, Tulsa, OK 74107
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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.

GRAHAM NATHAN JAMEISON MAT, ATC
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 237-2828
MARIYA BOBEN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
KARLYN TANZEY
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
KAYLEY ANTHAMATTEN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
CHASE YAGER
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (405) 613-1540
MACKENZIE LYNN HATTABAUGH
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972
ASHLEE EASTMAN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 805-1752
DAVID ROBERT WAXMAN
Student in an Organized Health Care Education/Training Program
1111 W 17TH ST
TULSA, OK 74107
Tulsa County (918) 582-1972

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 Keshawn Wallace's NPI number?

The NPI number for Keshawn Wallace is 1194532911. It was assigned to this individual provider in the NPPES registry on December 16, 2024.

Where is Keshawn Wallace located?

Keshawn Wallace practices at 1111 W 17th St, Tulsa, OK 74107. The listed phone number is (918) 582-1972.

What is Keshawn Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Keshawn Wallace was last updated on December 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.