Healthcare Provider Details

I. General information

NPI: 1083536148
Provider Name (Legal Business Name): SEKESHIA WALLACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 OLD HENDERSON RD
COLUMBUS OH
43220-3644
US

IV. Provider business mailing address

6227 KINGVIEW DR
HILLIARD OH
43026-0270
US

V. Phone/Fax

Practice location:
  • Phone: 614-442-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number161903
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: