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Elizabeth Ann Wallace

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2001 Laurel Ave Ste 105, Knoxville, TN 37916-1867

PECOS Enrollment

This provider is enrolled in PECOS as ELIZABETH WALLACE.

Based on the most recent information from CMS, provider Elizabeth Ann Wallace is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1982159356
Provider Type
Individual
Full Name
Wallace, Elizabeth Ann
Credential
FNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
8/16/2016
Last Updated
9/6/2024

Contact Information

Practice Location

2001 Laurel Ave Ste 105, Knoxville, TN 37916-1867

(865) 577-9247

(833) 908-2095

Mailing Location

1275 Dick Lonas Rd, Knoxville, TN 37909-1382

(865) 584-4747

(865) 381-1509

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 21538 Tennessee
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 21538 Tennessee

Elizabeth Ann Wallace

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Greer, Erick A

Payne, Rachel

Brumbach, Jennifer L

Rouse, Mary Katrina Quist

Irwin, James Tyler

Haynes, Christy

Setser, Jennifer Kathleen

Bryant, Vincent H.

Hurst, Natalie Ann Civinelli

Salem, Randa Khalid