KISHA WALLACE
NPI 1417433939
Nurse Practitioner - Adult Health in New York, NY

Q: What is Kisha Wallace's NPI number?

The NPI number for Kisha Wallace is 1417433939. It was assigned to this individual provider in the NPPES registry on July 17, 2018.

Q: What is Kisha Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Kisha Wallace was last updated on June 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 July 17, 2018PECOS Enrolled

1 GUSTAVE L LEVY PL, NEW YORK, NY 10029(212) 241-6500(212) 426-5040 Get Directions Write a Review

NPPES record last updated: June 9, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 9, 2021, Jul 17, 2018 (2 updates tracked since 2018).

On this page

About Kisha Wallace NPPES

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

KISHA WALLACE (NPI 1417433939) is an individual adult health provider in New York, New York, licensed in New York (F308252) and active in the NPI registry since July 2018. She is enrolled in Medicare PECOS and maintains a secondary practice location in West Hempstead.

NPPES Registry Identity

NPI1417433939

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameKISHA WALLACE

Location Address1 GUSTAVE L LEVY PLNew York, NY 10029-6504

Mailing Address150 E 42nd St # 3000New York, NY 10017-5612 · (646) 605-8119

Phone(212) 241-6500

Fax(212) 426-5040

Sole ProprietorYes

Enumeration DateJuly 17, 2018

Last NPPES UpdateJune 9, 20212 updates tracked since enumeration

NPPES CertifiedJune 9, 2021

✔ NPI 1417433939 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

License✔ Licensed in NY · F308252

1 GUSTAVE L LEVY PL, New York, NY 10029

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Secondary Practice Location 1

Location 1320 Wilson StWest Hempstead, NY 11552-2019 · Phone (516) 485-5864

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kisha Wallace is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 10029 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

$102.04 typical visit price

range $65.69 – $198.19

Typical copayment $25.51 (range $16.42 – $49.54)

Most-billed visit code 99203

Established Patient

$114.88 typical visit price

range $21.20 – $160.66

Typical copayment $28.72 (range $5.30 – $40.16)

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.

MRS. LAURA MANNING R.D., C.D.N.

Dietitian, Registered

1 GUSTAVE L LEVY PL, BOX 1625
NEW YORK, NY 10029

New York County (212) 241-9426

AMY JAYANT SANGHVI MD

Emergency Medicine

1 GUSTAVE L LEVY PL, BOX 1149
NEW YORK, NY 10029

New York County (212) 241-0748

MOUNT SINAI MEDICAL CENTER

General Acute Care Hospital

1 GUSTAVE L LEVY PL
NEW YORK, NY 10029

New York County (800) 637-4624

ANURADHA LALA-TRINDADE

Internal Medicine (Cardiovascular Disease)

1 GUSTAVE L LEVY PL
NEW YORK, NY 10029

New York County (212) 987-3100

RENA DYMERSKY RPA-C, MS

Physician Assistant

1 GUSTAVE L LEVY PL
NEW YORK, NY 10029

New York County (212) 241-6500

JENNY H CHUNG PHARMD, RN, FNP-BC

Nurse Practitioner (Family)

1 GUSTAVE L LEVY PL, TRANSPLANT INST. DEPARTMENT BOX 1104
NEW YORK, NY 10029

New York County (212) 659-8006

ERIKA JACOBSON RD,CDN

Dietitian, Registered

1 GUSTAVE L LEVY PL
NEW YORK, NY 10029

New York County (917) 241-5633

SARAH ALICIA REDA

Student in an Organized Health Care Education/Training Program

1 GUSTAVE L LEVY PL
NEW YORK, NY 10029

New York County (212) 241-6500

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 Kisha Wallace's NPI number?

The NPI number for Kisha Wallace is 1417433939. It was assigned to this individual provider in the NPPES registry on July 17, 2018.

Where is Kisha Wallace located?

Kisha Wallace practices at 1 Gustave L Levy Pl, New York, NY 10029. The listed phone number is (212) 241-6500.

What is Kisha Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Kisha Wallace enrolled in Medicare?

Yes. Kisha Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kisha Wallace was last updated on June 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.