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

Cherry Wallace

Individual provider Gerontology Nurse Practitioner · NPI 1013886456

Cherry Wallace is a Nurse Practitioner in Saint Louis, Missouri. Qualified in 2025, 1 year ago. Practices with Signature Medical Group Inc, a 40-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Missouri.

Years since qualifying
1
Licensed in
MO
In the registry since
2025
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

425 N New Ballas Rd Ste 203
Saint Louis, MO 63141-6848
Phone: (314) 872-3104
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 2025047590 (MO)

Record details

NPI number1013886456
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 3, 2025
Last updated in NPPESNovember 4, 2025
Certification dateNovember 4, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Signature Medical Group Inc — 40 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Saint Louis