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

Kyle Wallace

Individual provider Registered Nurse · NPI 1205258258

Kyle Wallace is a Registered Nurse in Bronx, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2014
Specialties on file
2
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Practice location Address checks out

2015 Grand Concourse
Bronx, NY 10453-4303
Phone: (718) 583-7736
Fax: (718) 537-6180
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence F311097-01 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 546269-1 (NY)

Record details

NPI number1205258258
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 10, 2014
Last updated in NPPESNovember 14, 2024
Certification dateNovember 14, 2024

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