Cherry Wallace, FNP

Gerontology Nurse Practitioner · Saint Louis, MO

Individual Active NPI

NPI number 1013886456

Practice location

425 N New Ballas Rd Ste 203
Saint Louis, MO 63141-6848
Phone
(314) 872-3104

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NPI record

NPI
1013886456
Entity type
Individual (Type 1)
Enumeration date
November 3, 2025
Last updated
August 19, 2026
Certified
August 19, 2026
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Gerontology Nurse Practitioner Primary 363LG0600X 2025047590 MO

Mailing address

905 Chestnut Ridge Rd
Manchester, MO 63021-6925
Phone
(314) 536-1897
Fax
(314) 536-1897

Other practice locations (2)

  • 3009 N Ballas Rd Ste 100B, Saint Louis, MO 63131-2322 · (314) 432-1111
  • 1400 LeMay Ferry Rd, Saint Louis, MO 63125-2408 · (314) 685-8721

About Cherry Wallace

Cherry Wallace, FNP is a healthcare provider registered in the NPI registry with the primary taxonomy Gerontology Nurse Practitioner (code 363LG0600X). The practice location is 425 N New Ballas Rd Ste 203, Saint Louis, MO 63141-6848. The NPI number 1013886456 was assigned on November 3, 2025 and the record was last updated on August 19, 2026.

Cherry Wallace lists a license in the registry: #2025047590 (MO) for Gerontology Nurse Practitioner. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Cherry Wallace, FNP?

The NPI number is 1013886456.

What is the phone number of Cherry Wallace?

The phone number listed for the practice location is (314) 872-3104.

Where is Cherry Wallace located?

425 N New Ballas Rd Ste 203, Saint Louis, MO 63141-6848.

What is the taxonomy code for Cherry Wallace?

The primary taxonomy code is 363LG0600X – Gerontology Nurse Practitioner.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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