Jesse L Wallace, AG-ACNP is a
Nurse Practitioner - Acute Care physician based in Charlottesville, Virginia. Jesse L Wallace is licensed to practice in Virginia (license number 0024187479) and his current practice location is 1215 Lee St, Charlottesville, Virginia. He can be reached at his office (for appointments etc.) via phone at
(434) 924-3627.
NPI number for Jesse L Wallace is 1013697267 and his current mailing address is Po Box 749112, Atlanta, Georgia. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1013697267.
Physician's Profile
| Full Name | Jesse L Wallace |
|---|
| Gender | Male |
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| Speciality | Nurse Practitioner - Acute Care |
|---|
| Location | 1215 Lee St, Charlottesville, Virginia |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1013697267
- Provider Enumeration Date: 07/24/2023
- Last Update Date: 12/06/2024
Medical Identifiers
Medical identifiers for Jesse L Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1013697267 | NPI | - | NPPES |
| NONE | Other | | NONE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207LC0200X | Anesthesiology - Critical Care Medicine | 0024187479 (Virginia) | Secondary |
| 363LA2100X | Nurse Practitioner - Acute Care | 0024187479 (Virginia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jesse L Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jesse L Wallace, AG-ACNP
Po Box 749112,
Atlanta, GA 30374-9112
Ph: () - | Jesse L Wallace, AG-ACNP
1215 Lee St,
Charlottesville, VA 22908-0816
Ph: (434) 924-3627 |
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