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

Katie Justine Wallace, FNP-BC

Individual provider Nurse Practitioner · NPI 1790151967

Katie Justine Wallace, FNP-BC is a Nurse Practitioner in Mashpee, Massachusetts. Qualified in 2014, 12 years ago. Practices with Pembroke Medical Associates Inc, a 26-clinician group and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
12
Licensed in
MA
In the registry since
2015
Specialties on file
2
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

Mashpee Family Medicine 5 Industrial Dr Ste 100
Mashpee, MA 02649
Phone: (508) 477-4282
Fax: (508) 539-6134
Show map & directions

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence RN2264353 (MA)
Nurse Practitioner Taxonomy 363L00000X · Licence RN2264353 (MA)

Record details

NPI number1790151967
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-BC
Sole proprietorNo
NPI enumeratedAugust 11, 2015
Last updated in NPPESJanuary 4, 2016

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Pembroke Medical Associates Inc — 26 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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