Marty Dale Wallace, CRNA
Certified Registered Nurse Anesthetist · Johnson City, TN
Marty Dale Wallace, CRNA is a certified registered nurse anesthetist with a practice address in Johnson City, Tennessee, and NPI 1164674743, issued on Oct 15, 2008. Check the license (Tennessee APN13700, as entered in NPPES) with the Tennessee board that licenses this profession; the Medicare figures below come from public CMS files.
- Name
- Marty Dale Wallace
- Credential
- CRNA
- Primary taxonomy
- Certified Registered Nurse Anesthetist 367500000X
- License number
- APN13700 TN
Self-reported in NPPES; status is on the state search - Practice location
- 1114 Sunset Dr, Johnson City, TN 37604
- Phone
- (423) 283-0776
- Enumerated
- Oct 15, 2008
- Record last updated
- Nov 20, 2009 (not updated in 17 years: call before relying on the address or phone)
- Fax
- (423) 283-0549
- Medicaid ID
- 1510077 TN
- Medicare enrollment
- Enrolled (PECOS I20110610000365); accepts Medicare assignment
- Entity
- Type 1 · individual
8 nearest certified registered nurse anesthetist records → All 3,117 in Tennessee → Look up another NPI →
Also registered at 1114 Sunset Dr
A shared address usually means a shared clinic or building; it does not show who employs whom.
- Robert Ashburn, M.D.Anesthesiology Physician1831195742
- Joanne Backofen, M.D.Anesthesiology Physician1114924537
- Dan Branon, CRNACertified Registered Nurse Anesthetist1174508964
- Joseph Brown, M.D.Anesthesiology Physician1477551828
- Jerry Bullard, CRNACertified Registered Nurse Anesthetist1598765919
- Patricia Cathelyn, CRNACertified Registered Nurse Anesthetist1851393805
Verify Marty Dale Wallace in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersWhich Tennessee board licenses this profession
Search for license APN13700Check the board - 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
Industry payments in 2024: $31.53
2 payments; by number, the most common kind was food and beverage; the largest payer was Medtronic, Inc. The 24,076 providers of this specialty with any payment received $135.08 on average. Payments are reported by manufacturers, not by the provider, and are not a sign of wrongdoing.
Source: CMS Open Payments, program year 2024 (openpaymentsdata.cms.gov); average among providers of this specialty with at least one payment.
Bills Medicare through one group practice
- Huntsville Hospital AnesthesiaHuntsville, AL
Source: CMS Doctors and Clinicians National Downloadable File (the group practices a clinician bills Medicare through) (data.cms.gov).
Marty Dale Wallace among 3,117 certified registered nurse anesthetist records in Tennessee
Marty Dale Wallace, CRNA is one of 3,117 certified registered nurse anesthetist records with a practice address in Tennessee. 81% of them appear in a Medicare file (Part D prescribing, MIPS, Open Payments or Medicare group billing); this one does. Its NPI, issued in 2008, is newer than 40% of them.
- NPI issued2008 · 40% of these records are older, 56% newer
- In a Medicare fileYes · 81% of these records are
- In the CMS Doctors and Clinicians fileYes · 76% of these records are
- Graduated2008 · median 2012 among the 2,370 with a school on file
- Record last updated2009 · 58% of these records were not updated in five years or more
Source: CMS NPPES, file of Aug 9, 2026, every record with primary taxonomy 367500000X and a Tennessee practice address; Medicare files: CMS Part D Prescribers 2024, MIPS 2023, Open Payments 2024, Doctors and Clinicians (data.cms.gov).
86 certified registered nurse anesthetist records list a practice address in Johnson City
They are 86 of the 3,807 NPPES records with a practice address in Johnson City, and 3,117 certified registered nurse anesthetist records in Tennessee.
All 3,117 in Tennessee → Every provider in Johnson City → Certified Registered Nurse Anesthetist nationwide →
The 8 certified registered nurse anesthetist records with the nearest ZIP codes
- Sheila Beasley, CRNAJohnson City, TN 376041861493793
- Jerry Bullard, CRNAJohnson City, TN 376041598765919
- Jodi Carlsen, CRNAJohnson City, TN 376041093707986
- Patricia Cathelyn, CRNAJohnson City, TN 376041851393805
- Larry Cornwell, CRNAJohnson City, TN 376041841292810
- Samuel Davenport, CRNAJohnson City, TN 376041083616056
- Amy Erickson, CRNAJohnson City, TN 376041528060423
- Donna Fowler, CRNAJohnson City, TN 376041144222894
Common questions
What is Marty Dale Wallace, CRNA's NPI number?
Marty Dale Wallace, CRNA's National Provider Identifier (NPI) is 1164674743, issued on Oct 15, 2008. An NPI identifies a provider in billing; it is not a license.
Where is Marty Dale Wallace, CRNA located?
The NPPES record lists a practice address at 1114 Sunset Dr, Johnson City, TN, 37604. Phone: (423) 283-0776. Providers update this record themselves, so call before visiting.
How can I verify Marty Dale Wallace, CRNA's license?
NPPES lists Tennessee license number APN13700, as entered by the provider. Search the Tennessee board that licenses this profession; the NPPES record confirms identity only.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.