NIKKI L WALLACE (CRNA) – Certified Registered Nurse Anesthetist, NPI 1104875459

Certified Registered Nurse Anesthetist

NIKKI L WALLACE (CRNA) is a healthcare provider. based in Dyersburg, Tennessee. specializing in Certified Registered Nurse Anesthetist. They hold the professional credentials CRNA. They hold a License No. 9725 (TN). The NPI Number for NIKKI L WALLACE (CRNA) is 1104875459

Main info

Female

28 Years Of Experience

Accepts Medicare Assignment

Name

NIKKI L WALLACE (CRNA)

NPI

1104875459

Phone

(731) 285-2410

Address

400 E Tickle St

Enumeration Date

6 May 2006

Last Update Date

17 March 2018

Doctor Profile

Medical School Name

OTHER

Secondary Phone

9018441590

Graduation Year

1998 (28 years ago)

PAC ID

2567475957

Group Practice PAC ID

2668658493

Professional Enrollment ID

I20060802000171

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience54

Completeness75

Years active:20State licenses:1Digital endpointsOther names

Provider Addresses for NIKKI L WALLACE (CRNA)

400 E Tickle St
Dyersburg, TN 380243120
Phone: (731) 285-2410
Type: Location
202, 29th Avenue North, Nashville, Davidson County, Tennessee, 37203, United States
NASHVILLE, TN 372031448
Phone: (615) 327-4304
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $13.

Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.

Last reported payment date: 2023-08-10 • Largest payer in this snapshot: Boston Scientific Corporation ($13).

Total Amount

$13

General + Research + Ownership

Payments

Total payment records

General Amount

$13

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2023-08-10

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
Boston Scientific Corporation	$13

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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 38024)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 2668658493View full group profile

Name	Specialty	State
MICAH BEST (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN
MR. STEVEN C DEPASS (CRNA, MS)	-	TN
PAULINA WILLIAMSON (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN
DR. BROJO SARKAR (MD)	A N E S T H E S I O L O G Y	TN
JEFFREY WILLIAMS (MD)	A N E S T H E S I O L O G Y	TN
STEPHEN T FINDER (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN
SARAH E. HEATON (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN
JANET HUDSON (CRNA)	-	TN
JON-DAVID NICHOLAS PRICE	Certified Registered Nurse Anesthetist (Crna)	TN
DANA STICKLEY (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN

Reviews

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Frequently asked questions

Does NIKKI L WALLACE (CRNA) have a public NPI I can cite?

Public records show NIKKI L WALLACE (CRNA) under NPI 1104875459.

Does the public listing show NIKKI L WALLACE (CRNA) as active?

NIKKI L WALLACE (CRNA)'s NPI record reflects an active status in NPPES.

What services align with NIKKI L WALLACE (CRNA)'s listing?

NIKKI L WALLACE (CRNA)'s public classification highlights Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.

Which community is linked to NIKKI L WALLACE (CRNA)?

NIKKI L WALLACE (CRNA) shows a connection to Dyersburg, Tennessee in registry-derived data.

Can I export NIKKI L WALLACE (CRNA)'s record?

You can download the official NPPES record; we summarize key fields for readability.