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

Kyle Wallace

Individual provider Registered Nurse · NPI 1205258258

Kyle Wallace is a Registered Nurse in Bronx, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2014
Specialties on file
2

Practice location Address checks out

2015 Grand Concourse
Bronx, NY 10453-4303
Phone: (718) 583-7736
Fax: (718) 537-6180
Show map & directions

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

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence F311097-01 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 546269-1 (NY)

Record details

NPI number1205258258
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 10, 2014
Last updated in NPPESNovember 14, 2024
Certification dateNovember 14, 2024
Mailing address2626 Halperin Ave, Bronx, NY 10461-2631

Other providers in Bronx