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

Mrs. Phyllis A Wallace, APRN

Individual provider Women's Health Nurse Practitioner · NPI 1366486417

Mrs. Phyllis A Wallace, APRN is a Nurse Practitioner in Konawa, Oklahoma. Graduated from University of Nebraska College of Medicine in 2002, 24 years ago. Practices with Central Oklahoma Family Medical Center Inc, a 57-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
24
Trained at
University of Nebraska College of Medicine
Licensed in
OK
In the registry since
2006
Specialties on file
2
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

See every abbreviation used in this directory →

Practice location Address checks out

527 W 3rd St
Konawa, OK 74849-1415
Phone: (580) 925-3286
Fax: (580) 925-9149
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 35497 (OK)
Women's Health Nurse Practitioner Taxonomy 363LW0102X · Licence R0035497 (OK)

Record details

NPI number1366486417
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRN
Sole proprietorNo
NPI enumeratedJune 16, 2006
Last updated in NPPESNovember 22, 2021
Certification dateNovember 22, 2021

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
Graduated 2002 (24 years in practice)
Group practice Central Oklahoma Family Medical Center Inc — 57 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount