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

Kyrsten Wallace, MD

Individual provider Family Medicine Physician · NPI 1407317472

Kyrsten Wallace, MD is a Family Practice in Syracuse, New York. Qualified in 2019, 7 years ago. Practices with Upstate Family and Preventive Medicine Inc, a 31-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
7
Licensed in
NY
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

750 E Adams St
Syracuse, NY 13210-2306
Phone: (315) 464-8948
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 318197 (NY)

Record details

NPI number1407317472
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 30, 2019
Last updated in NPPESDecember 13, 2022
Certification dateDecember 13, 2022
Mailing address4900 Broad Rd Ste 3m, Syracuse, NY 13215-2265

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Upstate Family And Preventive Medicine Inc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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