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WALLIS DERMATOLOGY ASSOCIATES PLLC
NPI 1396945234
Dermatology in Longview, TX

Active since July 19, 2007CLIA Certified · 3 labs
3535 N FOURTH ST STE 400, LONGVIEW, TX 75605(903) 757-3881(903) 757-5948 Get Directions Write a Review

NPPES record last updated: February 13, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 30, 2024, Oct 14, 2021, Mar 3, 2021 and 1 more (4 updates tracked since 2019).

About Wallis Dermatology Associates Pllc NPPES

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

WALLIS DERMATOLOGY ASSOCIATES PLLC (NPI 1396945234) is a healthcare organization registered as a dermatology in Longview, Texas and active in the NPI registry since July 2007. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Elizabeth Bowen, Credentialing Officer, as its authorized official.

NPPES Registry Identity

NPI1396945234
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameWALLIS DERMATOLOGY ASSOCIATES PLLC
Location Address3535 N FOURTH ST STE 400Longview, TX 75605-0038
Mailing Address3535 N Fourth St Ste 400Longview, TX 75605-0038 · (903) 757-3881 · Fax (903) 757-5948
Phone(903) 757-3881
Fax(903) 757-5948
Organization SubpartNo
Authorized OfficialElizabeth BowenCredentialing Officer · (903) 503-7330
Enumeration DateJuly 19, 2007
Last NPPES UpdateFebruary 13, 20264 updates tracked since enumeration
NPPES CertifiedFebruary 13, 2026
✔ NPI 1396945234 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in TX · H6685
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
3535 N FOURTH ST STE 400, Longview, TX 75605
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Secondary Practice Locations 2

Location 12365 Three Lakes PkwyTyler, TX 75703 · Phone (903) 991-4569 · Fax (430) 227-8328
Location 21900 S Washington Ave Ste EMarshall, TX 75670-6845 · Phone (903) 503-7330 · Fax (903) 503-7336

Other Identifiers 1

Medicaid302333501TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wallis Dermatology Associates Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Wallis Dermatology Associates PLLC, which bills Medicare for the services they deliver. Of these, 9 practice at this address. They are listed nearest first.

Clinicians by Medicare Specialty 2

Dermatology6
Nurse Practitioner5

Clinicians, nearest first (11)

Taylor Dickerson, MD
Dermatology
NPI 1154825974
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Laura Fite, M.D.
Dermatology
NPI 1861750416
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Robert Taylor, MD
Dermatology
NPI 1760441893
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Dorothy Womack, FNP-C
Nurse Practitioner
NPI 1003590282
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Casey English, APRN-CNP
Nurse Practitioner
NPI 1780259135
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Devor O'connor, MD
Dermatology
NPI 1811566250
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Tammi Short, FNP-C
Nurse Practitioner
NPI 1538137153
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Luke Wallis, MD
Dermatology
NPI 1144724717
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Mark Wallis, M.D.
Dermatology
NPI 1861489049
3535 N FOURTH ST STE 400
Longview, TX 75605
(903) 757-3881
✔ PECOS✔ Accepts MedicareSame address
Kimberly Calderon, FNP
Nurse Practitioner
NPI 1538681754
1900 S WASHINGTON AVE STE E
Marshall, TX 75670
(903) 503-7330
✔ PECOS✔ Accepts Medicare21 mi
Kandiss Hearn, APRN, FNP-C
Nurse Practitioner
NPI 1336774405
2365 THREE LAKES PKWY
Tyler, TX 75703
(903) 991-4569
✔ PECOS✔ Accepts Medicare41 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 45D2334912

Wallis Dermatology Assoc, PLLC · Tyler, TX
Active · expires Dec 2, 2027
CLIA Number45D2334912
Laboratory TypePhysician Office
Certificate Effective DateDecember 3, 2025
Certificate Expiration DateDecember 2, 2027
Laboratory DirectorMark S. Wallis
Laboratory Phone(903) 991-4569
Laboratory LocationWallis Dermatology Assoc, PLLC2365 Three Lakes Parkway, Tyler, TX 75703
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D2135593

Wallis Dermatology Associates, PLLC · Marshall, TX
Active · expires Aug 6, 2027
CLIA Number45D2135593
Laboratory TypePhysician Office
Certificate Effective DateAugust 7, 2025
Certificate Expiration DateAugust 6, 2027
Laboratory DirectorMark S. Wallis
Laboratory Phone(903) 503-7330
Laboratory LocationWallis Dermatology Associates, PLLC1900 S Washington, Suite E, Marshall, TX 75670
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Compliance 45D0684764

Wallis Dermatology Associates PLLC · Longview, TX
Active · expires Nov 7, 2026
CLIA Number45D0684764
Laboratory TypePhysician Office
Certificate Effective DateNovember 8, 2024
Certificate Expiration DateNovember 7, 2026
Laboratory DirectorMark S. Wallis
Laboratory Phone(903) 757-3881
Laboratory LocationWallis Dermatology Associates PLLC3535 North 4th Street, Suite 400, Longview, TX 75605
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Wallis Dermatology Associates PLLC's NPI number?

The NPI number for Wallis Dermatology Associates PLLC is 1396945234. It was assigned to this organization in the NPPES registry on July 19, 2007.

Where is Wallis Dermatology Associates PLLC located?

Wallis Dermatology Associates PLLC is located at 3535 N Fourth St Ste 400, Longview, TX 75605. The listed phone number is (903) 757-3881.

What is Wallis Dermatology Associates PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Wallis Dermatology Associates PLLC enrolled in Medicare?

Yes. Wallis Dermatology Associates PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Wallis Dermatology Associates PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 2 Medicare specialties reassign their Medicare billing to Wallis Dermatology Associates PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (6) and Nurse Practitioner (5). Of these, 9 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Wallis Dermatology Associates PLLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Wallis Dermatology Associates PLLC was last updated on February 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.