Melissa Kay Wallis, AGNP
Nurse Practitioner in Saint Louis, MO. Individual provider (NPI-1).
NPI number1346705993
StatusActive
Last updated in NPPESNov 15, 2021
Details
- NPI
- 1346705993
- Entity type
- Individual (NPI-1)
- Name
- Ms. Melissa Kay Wallis
- Credential
- AGNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 7, 2019
- Last updated
- Nov 15, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 2019005399 | MO | Yes |
Practice location
4921 Parkview PlDiv Neuro Surg, Ste 6b/6c
Saint Louis, MO 63110-1032
Phone 314-362-3577 · Fax 314-362-2107
Mailing address
660 S Euclid AveCb 8057
Saint Louis, MO 63110-1010
Phone 314-747-6174 · Fax 314-362-2107
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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