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

Shane K Wallace, CRNA

Individual provider Registered Nurse · NPI 1235378605

Shane K Wallace, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Pikeville, Kentucky. Qualified in 2008, 18 years ago. Practices with Pikeville Medical Center Inc, a 428-clinician group and accepts Medicare assignment. Licensed in Kentucky, Tennessee and Virginia.

Years since qualifying
18
Licensed in
KY, TN, VA
In the registry since
2009
Specialties on file
4
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

See every abbreviation used in this directory →

Practice location Address checks out

911 Bypass Rd Bldg A
Pikeville, KY 41501-1689
Phone: (606) 430-3500
Fax: (606) 437-1033
Show map & directions

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

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 3008218 (KY)
Registered Nurse Taxonomy 163W00000X · Licence 0001179608 (VA)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 0024168171 (VA)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 33501 (TN)

Record details

NPI number1235378605
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedFebruary 9, 2009
Last updated in NPPESAugust 2, 2023
Certification dateAugust 2, 2023
Mailing addressPo Box 432, Pikeville, KY 41502-0432

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Pikeville Medical Center Inc — 428 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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