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

Brooke Melanie Wallace, PA

Individual provider Physician Assistant · NPI 1083504740

Brooke Melanie Wallace, PA is a Physician Assistant in Henderson, Nevada. Qualified in 2025, 1 year ago. Practices with Nevada Health Tanita PLLC, a 6-clinician group and accepts Medicare assignment.

Years since qualifying
1
In the registry since
2025
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1348 Paseo Verde Pkwy Ste 100
Henderson, NV 89012-5723
Phone: (702) 847-6252
Fax: (702) 847-6254
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1083504740
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedJuly 5, 2025
Last updated in NPPESApril 23, 2026
Certification dateApril 23, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Nevada Health Tanita Pllc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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