Provider Demographics
NPI:1700769130
Name:WALLACE, KRISTEN ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:WALLACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N SCOTT ST APT 1065
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2971
Mailing Address - Country:US
Mailing Address - Phone:214-926-3261
Mailing Address - Fax:
Practice Address - Street 1:660 L ST NW STE 430
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3615
Practice Address - Country:US
Practice Address - Phone:202-677-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001294252163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health