Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Aundrea Leighann Wallace

Individual provider Family Nurse Practitioner · NPI 1053930404

Aundrea Leighann Wallace is a Nurse Practitioner in Knoxville, Tennessee. Graduated from East Tennessee State University Quillen College of Medicine in 2019, 7 years ago. Practices with Summit Medical Group, PLLC, a 636-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
7
Trained at
East Tennessee State University Quillen College of Medicine
Licensed in
TN
In the registry since
2020
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Practice location Address checks out

103 Midlake Dr Uppr Level
Knoxville, TN 37918-3002
Phone: (865) 687-1973
Fax: (833) 908-2091
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 27443 (TN)

Record details

NPI number1053930404
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 15, 2020
Last updated in NPPESNovember 15, 2024
Certification dateNovember 15, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolEAST TENNESSEE STATE UNIVERSITY QUILLEN COLLEGE OF MEDICINE
Graduated 2019 (7 years in practice)
Group practice Summit Medical Group, Pllc — 636 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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