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

Cameron Blake Wallace, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1174456578

Cameron Blake Wallace, CRNA is a Certified Registered Nurse Anesthetist in Charleston, West Virginia. Licensed in West Virginia. Registered with an NPI since 2026.

Licensed in
WV
In the registry since
2026
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone: (304) 388-5432
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 109296 (WV)

Record details

NPI number1174456578
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJune 4, 2026
Last updated in NPPESAugust 3, 2026
Certification dateAugust 3, 2026

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