| William Jacob Wallace, PA | |
|
105 S Willow Ave, Cookeville, TN 38501-4667 | |
| (931) 372-7716 | |
| (931) 372-0087 |
| Full Name | William Jacob Wallace |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 10 Years |
| Location | 105 S Willow Ave, Cookeville, Tennessee |
| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992183412 | NPI | - | NPPES |
| Q015216 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 2743 (Tennessee) | Secondary |
| 363AS0400X | Physician Assistant - Surgical | PA2743 (Tennessee) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Cookeville Regional Medical Center | Cookeville, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Campbell Clinic Pc | 9638082076 | 142 |
| Mailing Address | Practice Location Address |
|---|---|
| William Jacob Wallace, PA 203 N Cedar Ave, Cookeville, TN 38501-2498 Ph: (931) 528-1992 | William Jacob Wallace, PA 105 S Willow Ave, Cookeville, TN 38501-4667 Ph: (931) 372-7716 |
Cheryl A Cunningham, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 228 W 4th St Ste 200, Cookeville, TN 38501 Phone: 931-372-0405 | |
Pamela Shelton Dobbs, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 145 W 4th St Ste 201, Cookeville, TN 38501 Phone: 931-783-2143 | |
Mrs. Lacie Dillon, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 103 W Main St Ste C, Cookeville, TN 38506 Phone: 931-218-6463 | |
Caitlin Locke, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 340 N Cedar Ave, Cookeville, TN 38501 Phone: 931-783-5353 Fax: 931-783-4994 | |
James M Vance, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 350 S Lowe Ave, Suite A, Cookeville, TN 38501 Phone: 931-526-1050 Fax: 931-526-8163 | |
Molly Kate Campbell, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 406 N Whitney Ave Ste 5, Cookeville, TN 38501 Phone: 931-783-4269 | |
Lexie Nicolette Gabbard, Physician Assistant Medicare: Medicare Enrolled Practice Location: 165 Maple Valley Ln, Cookeville, TN 38506 Phone: 931-265-9815 |