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

Kimberly Lane Wallace, NP-C

Individual provider Primary Care Nurse Practitioner · NPI 1619688116

Kimberly Lane Wallace, NP-C is a Primary Care Nurse Practitioner in Beavercreek, Ohio. Licensed in Ohio. Registered with an NPI since 2022.

Licensed in
OH
In the registry since
2022
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

See every abbreviation used in this directory →

Practice location Address checks out

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone: (937) 702-4000
Show map & directions

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

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence APRN.CNP.0032777 (OH)

Record details

NPI number1619688116
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP-C
Sole proprietorNo
NPI enumeratedDecember 6, 2022
Last updated in NPPESDecember 6, 2022
Certification dateDecember 6, 2022

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