STACI L WALL NP
NPI 1629068291
Nurse Practitioner in Fort Wayne, IN

Q: What is Staci Wall's NPI number?

The NPI number for Staci Wall is 1629068291. It was assigned to this individual provider in the NPPES registry on October 25, 2005.

Q: What is Staci Wall'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 Staci Wall was last updated on January 31, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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 October 25, 2005

7988 W JEFFERSON BLVD, FORT WAYNE, IN 46804(260) 432-4400(260) 969-6898 Get Directions Write a Review

NPPES record last updated: January 31, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Staci L Wall Np NPPES

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

STACI L WALL NP (NPI 1629068291) is an individual nurse practitioner in Fort Wayne, Indiana, licensed in Indiana (71003769) and active in the NPI registry since October 2005.

NPPES Registry Identity

NPI1629068291

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameSTACI L WALLCredential: NP

Location Address7988 W JEFFERSON BLVDFort Wayne, IN 46804-4140

Mailing Address2518 E Dupont RdFort Wayne, IN 46825-1675 · (260) 432-4400 · Fax (260) 969-6898

Phone(260) 432-4400

Fax(260) 969-6898

Sole ProprietorNo

Enumeration DateOctober 25, 2005

Last NPPES UpdateJanuary 31, 2018

✔ NPI 1629068291 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IN · 71003769

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.

Also ListedRegistered NurseTaxonomy 163W00000X · License 28086186 (IN)

7988 W JEFFERSON BLVD, Fort Wayne, IN 46804

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Other Identifiers 1

Medicaid200338300IN

Other Providers at the Same Location NPPES 14

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

JESSICA LEFFERS FNP

Nurse Practitioner (Family)