MR. JASON DAVID WALLACE (NPI# 1235755638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235755638 |
| Entity Type | Individual |
| Full Name | MR. JASON DAVID WALLACE |
| Practice Address |
2616 Gallaway Cv Jonesboro AR 72404-7827 |
| Practice Telephone | 6156186200 |
| Mailing Telephone | 6156186200 |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-06-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
125806 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346698842 | Jason Wallace | Dentist | 1400 W Covell Rd, Edmond, OK 73003-3504 | 2016-05-25 |
| 1679713754 | Jason D Wallace | Behavioral Analyst | 104 Shoreview Ln, Oldsmar, FL 34677-4106 | 2009-03-02 |
| 1992020937 | Jason R Wallace | Family Medicine | 95 S Pagosa Blvd, Pagosa Springs, CO 81147-8329 | 2010-04-01 |
| 1689751166 | Jason Wallace | Optometrist | 502 Celebration Ave, Celebration, FL 34747-4687 | 2006-11-01 |
| 1013028612 | Jason R. Wallace | Radiology | 12554 Riata Vista Circle, Austin, TX 78727-6432 | 2006-08-31 |
| 1891786646 | Jason Scott Wallace | Physical Therapy Assistant | 2486 N Ponderosa Dr, Ste D-106, Camarillo, CA 93010-2376 | 2005-11-01 |
| Street Address |
2616 GALLAWAY CV |
| City | JONESBORO |
| State | AR |
| Zip Code | 72404-7827 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740745967 | Imove, LLC | Physical Therapist | 8700 S. Caraway Rd., Apt. L2, Jonesboro, AR 72404 | 2019-02-01 |
| 1245728914 | Karina Coats | Nurse Anesthetist, Certified Registered | 2409 Skyline Pt, Jonesboro, AR 72404 | 2018-04-27 |
| 1619325263 | Kathryn Meyers | Specialist/Technologist | 1614 Latourette Ln Apt 2, Jonesboro, AR 72404 | 2016-05-24 |
| 1922476571 | Tmj and Facial Pain Center,llc | Dentist | 2600 Browns Lane, Ste B, Jonesboro, AR 72404 | 2015-09-11 |
| 1265828156 | Hd Dental, Pa Dba Smile Dental | Dentist | 6009 Highway 1 South, Jonesboro, AR 72404 | 2015-04-08 |
| 1124445358 | Tanner Wilson Jarrett | Occupational Therapy Assistant | 3114 Fox Road Suite A, Jonesboro, AR 72404 | 2014-03-26 |
| 1154759793 | Kasey Boyd | Specialist/Technologist | 1717 Hwy 163, Jonesboro, AR 72404 | 2013-10-17 |
| 1578848610 | Maria Ivonne Norman | Physical Therapist | 8700 S. Caraway Rd. Apt. L2, (the Meadows), Jonesboro, AR 72404 | 2011-10-20 |
| 1003198839 | Rachel Hollimon Golden | Speech-Language Pathologist | 4410 Harrisburg Rd., Jonesboro, AR 72404 | 2011-09-19 |
| 1225358021 | Darrell R Gann | Physical Therapy Assistant | 6040 Beaver Creek, Jonesboro, AR 72404 | 2010-06-03 |
| Find all providers in zip 72404 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073099198 | Tiffany Spargo | Nurse Practitioner | 214 E Washington Ave, Jonesboro, AR 72401-3102 | 2018-07-11 |
| 1750705513 | Stacey Ogletree Lynch | Nurse Practitioner | 820 E Matthews Ave Ste F, Jonesboro, AR 72401-3081 | 2014-02-13 |
| 1669006359 | Megan Maureen Anderson | Nurse Practitioner | 2712 E Johnson Ave, Jonesboro, AR 72405-1874 | 2020-03-03 |
| 1518599091 | Marcie L Tuggle | Nurse Practitioner | 2707 Browns Ln, Jonesboro, AR 72401-7213 | 2020-02-12 |
| 1447817572 | Renew Mental Health and Wellness LLC | Nurse Practitioner | 820 E Matthews Ave Ste F, Jonesboro, AR 72401-3081 | 2019-05-23 |
| 1639654213 | Trisha Burns | Nurse Practitioner | 2712 E Johnson Ave, Jonesboro, AR 72401-1874 | 2018-09-28 |
| 1245719590 | Carrie Tate | Nurse Practitioner | 300 Carson St, Jonesboro, AR 72401-3104 | 2018-08-08 |
| 1861911091 | Barbara Turner | Nurse Practitioner | 2200 E Matthews Ave, Jonesboro, AR 72401-4347 | 2017-09-19 |
| 1427427368 | Melanie Ann Higgins | Nurse Practitioner | 2712 E Johnson Ave, Jonesboro, AR 72401-1874 | 2015-09-22 |
| 1750767299 | Kaitlyn Nugent | Nurse Practitioner | 615 E Matthews Ave, Suite A, Jonesboro, AR 72401-3145 | 2015-08-06 |
| Find all providers in JONESBORO | ||||
Please comment or provide details below to improve the information on MR. JASON DAVID WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.