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MRS. KRISTAL LEANN WALLACE FNP-BC
NPI 1801752449
Nurse Practitioner - Family in Edgewood, NM

Active since December 29, 2025PECOS EnrolledAccepts Medicare Assignment
1851 OLD US 66, EDGEWOOD, NM 87015(505) 286-2396 Get Directions Write a Review

NPPES record last updated: May 6, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 6, 2026, Dec 29, 2025 (2 updates tracked since 2025).

About Mrs. Kristal Leann Wallace Fnp-bc NPPES

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

MRS. KRISTAL LEANN WALLACE FNP-BC (NPI 1801752449) is an individual family provider in Edgewood, New Mexico, licensed in New Mexico (87084) and active in the NPI registry since December 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1801752449
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. KRISTAL LEANN WALLACECredential: FNP-BC
Location Address1851 OLD US 66Edgewood, NM 87015-7200
Mailing Address1851 Old Us 66Edgewood, NM 87015-7200 · (505) 286-2396
Phone(505) 286-2396
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateDecember 29, 2025
Last NPPES UpdateMay 6, 20262 updates tracked since enumeration
NPPES CertifiedMay 6, 2026
✔ NPI 1801752449 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in NM · 87084
1851 OLD US 66, Edgewood, NM 87015
Open in Google Maps ↗

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

Mrs. Kristal Leann Wallace Fnp-bc 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 ID6507344942
PECOS Enrollment IDI20260128002052
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 87015 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
$84.79 typical visit price
range $54.26 – $166.80
Typical copayment $21.19 (range $13.56 – $41.70)
Most-billed visit code 99203
Established Patient
$96.38 typical visit price
range $17.00 – $135.35
Typical copayment $24.09 (range $4.25 – $33.83)
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 9

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

ALYSSA BRIANA MIRABAL MD
Family Medicine
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396
CARLA RUDOLPH DO
General Practice
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396
HARRY SCHNEE MESSEC MD
Family Medicine
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396
SANDIA MOUNTAIN MEDICAL, INC.
Family Medicine
1851 OLD US 66, UNIT 1
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396
DR. SANFORD LEE YANKOW MD
Family Medicine
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396
BEBE MAKENA OTR/L
Occupational Therapist
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 281-8463
DR. LARISA MAUREEN HART VASQUEZ DPT
Physical Therapist
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 281-8463
JOSHUA JONES PA-C
Physician Assistant
1851 OLD US 66
EDGEWOOD, NM 87015
Santa Fe County (505) 286-2396

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 Kristal Wallace's NPI number?

The NPI number for Kristal Wallace is 1801752449. It was assigned to this individual provider in the NPPES registry on December 29, 2025.

Where is Kristal Wallace located?

Kristal Wallace practices at 1851 Old Us 66, Edgewood, NM 87015. The listed phone number is (505) 286-2396.

What is Kristal Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Kristal Wallace enrolled in Medicare?

Yes. Kristal 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.

When was this NPI record last updated?

The NPPES record for Kristal Wallace was last updated on May 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.