Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shereece Nichole Wallace, DNP, AGPCNP-BC

Individual provider Adult Health Nurse Practitioner · NPI 1104338318

Shereece Nichole Wallace, DNP, AGPCNP-BC is a Nurse Practitioner in Alton, Illinois. Qualified in 2017, 9 years ago. Practices with Fairview Heights Medical Group SC, a 448-clinician group, works from 5 locations and accepts Medicare assignment. Licensed in Illinois and Missouri.

Years since qualifying
9
Licensed in
IL, MO
In the registry since
2017
Specialties on file
3
What do these letters mean?
DNP — Doctor of Nursing Practice
The highest clinical degree in nursing.

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Practice location Address checks out

1 Memorial Dr
Alton, IL 62002-6722
Phone: (618) 463-7240
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (4)

  • 4500 Memorial Dr, Belleville, IL 62226-5360 — (618) 257-6220
  • 2122 Troy Rd Ste 130, Edwardsville, IL 62025-2540 — (618) 800-4500
  • 11133 Dunn Rd, Saint Louis, MO 63136-6163 — (314) 653-5000
  • 11155 Dunn Rd Ste 109n, Saint Louis, MO 63136-6148 — (314) 953-8799

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 209017027 (IL)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 209017027 (IL)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 2017038282 (MO)

Record details

NPI number1104338318
Entity typeIndividual (Type 1)
GenderFemale
Credentials DNP , AGPCNP-BC
Sole proprietorNo
NPI enumeratedOctober 27, 2017
Last updated in NPPESSeptember 25, 2025
Certification dateSeptember 25, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Fairview Heights Medical Group Sc — 448 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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