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

Tyler J Wallace, PMHNP-BC

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1114700739

Tyler J Wallace, PMHNP-BC is a Nurse Practitioner in Paducah, Kentucky. Qualified in 2023, 3 years ago. Practices with Mercy Health Physicians Kentucky Specialty Care LLC, a 147-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Kentucky.

Years since qualifying
3
Licensed in
KY
In the registry since
2023
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

See every abbreviation used in this directory →

Practice location Address checks out

1532 Lone Oak Rd Ste 345
Paducah, KY 42003-7942
Phone: (270) 444-2250
Fax: (270) 538-6596
Show map & directions

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

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 4005513 (KY)

Record details

NPI number1114700739
Entity typeIndividual (Type 1)
GenderMale
Credentials PMHNP-BC
Sole proprietorYes
NPI enumeratedAugust 16, 2023
Last updated in NPPESNovember 14, 2024
Certification dateNovember 14, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Mercy Health Physicians Kentucky Specialty Care Llc — 147 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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