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

Kelly Elizabeth Wallace, NP

Individual provider Nurse Practitioner · NPI 1417609694

Kelly Elizabeth Wallace, NP is a Nurse Practitioner in Petersburg, Virginia. Qualified in 2021, 5 years ago. Practices with Cep America LLC, a 985-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
5
Licensed in
VA
In the registry since
2022
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone: (804) 765-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 0024183547 (VA)

Record details

NPI number1417609694
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorYes
NPI enumeratedJanuary 19, 2022
Last updated in NPPESJanuary 27, 2022
Certification dateJanuary 27, 2022

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Cep America Llc — 985 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients215
Services billed 234 a service is one billed item, such as a visit, a test or a procedure
Average patient age73

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Cep America LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 985 clinicians in the practice; 12 are shown here.

Other providers in Petersburg