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JESSICA BOWMAN WALLACE NP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1619561321
Individual Registrant: JESSICA BOWMAN WALLACE NP
Gender: F
Not Sole Proprietor
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: --
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
Tel: 706-509-6110 Fax: 706-509-6101
Registration Information:
NPI: 1619561321
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | GA | RN241671 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
