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KELLY ELIZABETH WALLACE NP
NPI 1417609694
Nurse Practitioner in Petersburg, VA

Active since January 19, 2022PECOS EnrolledAccepts Medicare Assignment
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805(804) 765-5000 Get Directions Write a Review

NPPES record last updated: January 27, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 27, 2022, Jan 19, 2022 (2 updates tracked since 2022).

About Kelly Elizabeth Wallace Np NPPES

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

KELLY ELIZABETH WALLACE NP (NPI 1417609694) is an individual nurse practitioner in Petersburg, Virginia, licensed in Virginia (0024183547) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS, is affiliated with Bon Secours St Marys Hospital, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1417609694
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameKELLY ELIZABETH WALLACECredential: NP
Location Address200 MEDICAL PARK BLVDPetersburg, VA 23805-9274
Mailing Address2610 Setting Sun DrPowhatan, VA 23139-7552 · (910) 443-1679
Phone(804) 765-5000
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJanuary 19, 2022
Last NPPES UpdateJanuary 27, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2022
✔ NPI 1417609694 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 VA · 0024183547
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.
200 MEDICAL PARK BLVD, Petersburg, VA 23805
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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

Kelly Elizabeth Wallace Np 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 ID9537552286
PECOS Enrollment IDI20220202001007
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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
128 services127 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
74 services74 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Bon Secours St Marys Hospital

Acute Care Hospitals · Richmond, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number490059
Location5801 Bremo RdRichmond, VA 23226 · Richmond City County
Emergency services Birthing friendly

Bon Secours St Francis Medical Center

Acute Care Hospitals · Midlothian, VA
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number490136
Location13710 St Francis BoulevardMidlothian, VA 23114 · Chesterfield County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23805 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
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
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.

SARAH LIGHT
Student in an Organized Health Care Education/Training Program
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (804) 765-5000
DOUGLAS COHRS PA-C
Physician Assistant
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (703) 431-9975
SUDHA KODURU M.D.
Internal Medicine
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (804) 765-5991
BRIAN WAYNE MCCAULEY PA-C
Physician Assistant
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (804) 765-5000
DR. MICHAEL W CIESLINSKI M.D.
Emergency Medicine
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (804) 765-5000
DR. BENJAMIN ROSS QUIGLEY MD
Emergency Medicine
200 MEDICAL PARK BLVD, EMERGENCY DEPARTMENT
PETESBURG, VA 23805
Petersburg City (804) 765-5000
MARIBEL K ABENIR CRNA-NP
Nurse Anesthetist, Certified Registered
200 MEDICAL PARK BLVD, SOUTHSIDE REGIONAL MEDICAL CENTER
PETERSBURG, VA 23805
Petersburg City (804) 765-5000
JULIANA NAW
Student in an Organized Health Care Education/Training Program
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805
Petersburg City (804) 765-5000

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 Kelly Wallace's NPI number?

The NPI number for Kelly Wallace is 1417609694. It was assigned to this individual provider in the NPPES registry on January 19, 2022.

Where is Kelly Wallace located?

Kelly Wallace practices at 200 Medical Park Blvd, Petersburg, VA 23805. The listed phone number is (804) 765-5000.

What is Kelly Wallace's specialty?

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

Is Kelly Wallace enrolled in Medicare?

Yes. Kelly 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.

Is Kelly Wallace affiliated with any hospitals?

According to CMS data, Kelly Wallace is affiliated with Bon Secours St Marys Hospital and Bon Secours St Francis Medical Center.

When was this NPI record last updated?

The NPPES record for Kelly Wallace was last updated on January 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.