TYLER J WALLACE (PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1114700739
Psychiatric/Mental Health Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
7,343 NURSE PRACTITIONER in KY
Provider Addresses for TYLER J WALLACE (PMHNP-BC)
1532 LONE OAK RD STE 345
PADUCAH, KY 420037942
Phone: (270) 444-2250
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $357.
Total Amount is formed as General ($357) + Research ($0) + Ownership ($0) = $357.
Last reported payment date: 2024-10-10 • Largest payer in this snapshot: ABBVIE INC. ($250).
Total Amount
$357
General + Research + Ownership
Payments
5
Total payment records
General Amount
$357
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $250 |
| E.R. Squibb & Sons, L.L.C. | $107 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-12-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241213003096 | I | Nurse Practitioner | KY | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 42003)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Internal Medicine | TN | |
| Nurse Practitioner | KY | |
| P S Y C H I A T R Y | OH | |
| Nurse Practitioner | OH | |
| N E U R O S U R G E R Y | VA | |
| Certified Clinical Nurse Specialist (Cns) | OH | |
| Neurology, Internal Medicine | KY | |
| N E U R O L O G Y | OH | |
| U R O L O G Y | LA |
Reviews
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