MIRACLE ANN WALLS DO
NPI 1619771250
Student in an Organized Health Care Education/Training Program in Memphis, TN

Q: What is Miracle Walls's NPI number?

The NPI number for Miracle Walls is 1619771250. It was assigned to this individual provider in the NPPES registry on April 2, 2025.

Q: What is Miracle Walls's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Miracle Walls was last updated on April 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.

Active since April 02, 2025PECOS Enrolled

920 MADISON AVE STE 447, MEMPHIS, TN 38103(901) 287-6756 Get Directions Write a Review

NPPES record last updated: April 2, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Miracle Ann Walls Do NPPES

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

MIRACLE ANN WALLS DO (NPI 1619771250) is an individual student in an organized health care education/training program in Memphis, Tennessee and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619771250

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameMIRACLE ANN WALLSCredential: DO

Location Address920 MADISON AVE STE 447Memphis, TN 38103-3438

Mailing Address3074 Nathan Ave Apt 5Memphis, TN 38112-3660 · (901) 614-7628

Phone(901) 287-6756

Sole ProprietorNo

Enumeration DateApril 2, 2025

NPPES CertifiedApril 2, 2025

✔ NPI 1619771250 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.

920 MADISON AVE STE 447, Memphis, TN 38103

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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 (PECOS)

Miracle Ann Walls Do 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.

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.

DR. DAVID EDWARD ZIMMERHANZEL MD

Student in an Organized Health Care Education/Training Program