Individual
MATTHEW RICHARD WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APRN, PMHNP-BC
Contact information
Practice address
1000 S LIMESTONE, LEXINGTON, KY 40506-0007
(859) 562-7371
Mailing address
1000 S LIMESTONE, LEXINGTON, KY 40536-0001
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4044992
KY
Other
Enumeration date
02/10/2025
Last updated
03/03/2026
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