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JESSICA BOWMAN WALLACE NP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1619561321

Individual Registrant:
 JESSICA BOWMAN WALLACE NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
253 COUNTY ROAD 766  CEDAR BLUFF, AL 35959-3595 US
Tel: 256-899-9147  Fax: --

Contact information for business:
304 TURNER MCCALL BLVD SW  ROME, GA 30165-5621 US
Tel: 706-509-6110  Fax: 706-509-6101

Registration Information:
NPI: 1619561321
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
GARN241671

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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