KATHRYN MARY WALLACE APRN, BC
NPI 1407965320
Nurse Practitioner in Portage, IN

Q: What is Kathryn Wallace's NPI number?

The NPI number for Kathryn Wallace is 1407965320. It was assigned to this individual provider in the NPPES registry on August 30, 2006.

Q: What is Kathryn Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Kathryn Wallace was last updated on September 17, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.

Active since August 30, 2006

2640 HAMSTROM RD, PORTAGE, IN 46368(219) 762-4423(219) 763-3120 Get Directions Write a Review

NPPES record last updated: September 17, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kathryn Mary Wallace Aprn, Bc NPPES

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

KATHRYN MARY WALLACE APRN, BC (NPI 1407965320) is an individual nurse practitioner in Portage, Indiana, licensed in Indiana (71000473A) and active in the NPI registry since August 2006.

NPPES Registry Identity

NPI1407965320

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameKATHRYN MARY WALLACECredential: APRN, BC

Location Address2640 HAMSTROM RDPortage, IN 46368-3832

Mailing Address2640 Hamstrom RdPortage, IN 46368-3832 · (219) 762-4423 · Fax (219) 763-3120

Phone(219) 762-4423

Fax(219) 763-3120

Sole ProprietorNo

Enumeration DateAugust 30, 2006

Last NPPES UpdateSeptember 17, 2012

✔ NPI 1407965320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IN · 71000473A

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

2640 HAMSTROM RD, Portage, IN 46368

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Other Identifiers 4

Medicare UPINS57554

Medicare PINM400040658IN

Other500004228IN · Railroad Medicare

Medicaid200056120AIN

Other Providers at the Same Location NPPES 8

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

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