Shereece Nichole Wallace, DNP, AGPCNP-BC

Nurse Practitioner · Alton, IL

Individual Active NPI

NPI number 1104338318

Practice location

1 Memorial Dr
Alton, IL 62002-6722
Phone
(618) 463-7240

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NPI record

NPI
1104338318
Entity type
Individual (Type 1)
Enumeration date
October 27, 2017
Last updated
September 25, 2025
Certified
September 25, 2025
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Nurse Practitioner Primary 363L00000X 209017027 IL
Adult Health Nurse Practitioner 363LA2200X 209017027 IL
Adult Health Nurse Practitioner 363LA2200X 2017038282 MO

Mailing address

660 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8512
Phone
(314) 448-3791
Fax
(636) 996-7658

Other practice locations (4)

  • 4500 Memorial Dr, Belleville, IL 62226-5360 · (618) 257-6220
  • 11155 Dunn Rd Ste 109N, Saint Louis, MO 63136-6148 · (314) 953-8799
  • 2122 Troy Rd Ste 130, Edwardsville, IL 62025-2540 · (618) 800-4500
  • 11133 Dunn Rd, Saint Louis, MO 63136-6163 · (314) 653-5000

About Dr. Wallace

Shereece Nichole Wallace, DNP, AGPCNP-BC is a healthcare provider registered in the NPI registry with the primary taxonomy Nurse Practitioner (code 363L00000X). The practice location is 1 Memorial Dr, Alton, IL 62002-6722. The NPI number 1104338318 was assigned on October 27, 2017 and the record was last updated on September 25, 2025.

Dr. Wallace lists 3 licenses in the registry: #209017027 (IL) for Nurse Practitioner; #209017027 (IL) for Adult Health Nurse Practitioner; #2017038282 (MO) for Adult Health 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 Shereece Nichole Wallace, DNP, AGPCNP-BC?

The NPI number is 1104338318.

What is the phone number of Dr. Wallace?

The phone number listed for the practice location is (618) 463-7240.

Where is Dr. Wallace located?

1 Memorial Dr, Alton, IL 62002-6722.

What is the taxonomy code for Dr. Wallace?

The primary taxonomy code is 363L00000X – Nurse Practitioner; 2 more listed above.

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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