JACLYN RENEE WALLACE (NPI# 1326572801) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326572801 |
| Entity Type | Individual |
| Full Name | JACLYN RENEE WALLACE |
| Credential | NNP-BC |
| Practice Address |
1711 Tullie Cir Ne Atlanta GA 30329-2305 |
| Practice Telephone | 4047855413 |
| Practice Fax Number | 4047856233 |
| Mailing Telephone | 4047855413 |
| Mailing Fax Number | 4047856233 |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-04-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LN0005X |
Nurse Practitioner Specialization: Neonatal, Critical Care |
RN211895 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467953091 | Jaclyn Ann Wallace | Health Educator | 7800 W Outer Dr Ste 203, Detroit, MI 48235-3459 | 2018-02-28 |
| 1497947568 | Jaclyn Wallace | Occupational Therapist | 900 23rd St Nw, Washington, DC 20037-2342 | 2007-08-13 |
| Street Address |
1711 TULLIE CIR NE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30329-2305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326465659 | Sonya Mclaughlin | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2014-03-25 |
| 1932721461 | Ashley Murry | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2020-05-06 |
| 1669962684 | Hilary Antley Jones | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2018-05-15 |
| 1164935326 | Salina Patel | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2017-11-09 |
| 1245779149 | Caitlin Ezzell | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2017-02-13 |
| 1083156848 | Katherine Gruber Stephenson | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-11-10 |
| 1689125023 | Melissa Sue Pichetto | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-10-20 |
| 1205384211 | Jeanene Hill Bowman | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-09-19 |
| 1285094433 | Mussie Asmerom | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-03-01 |
| 1437518032 | Katherine Mcginnis | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-02-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871084111 | Inner Peace Counseling Services,llc | Counselor | 2801 Bufford Highway, Suite T-10, Atlanta, GA 30329 | 2018-05-22 |
| 1912409392 | Joie De Vivre Counseling and Therapy | Counselor | 2801 Buford Highway, Ne, Atlanta, GA 30329 | 2018-03-01 |
| 1902329105 | Barbara Dunbar | Psychologist | 1777 Northeast Expressway, #175, Atlanta, GA 30329 | 2017-07-19 |
| 1114449048 | Cricket Cheyenne Gullickson | Student in an Organized Health Care Education/Training Program | 1371 Briarvista Way Ne, Atlanta, GA 30329 | 2017-07-12 |
| 1902357866 | Carla Zimmerly | Nurse Practitioner | 1711 Tullie Circle, Atlanta, GA 30329 | 2016-10-17 |
| 1316490808 | Shahzad Ghori | Student in an Organized Health Care Education/Training Program | 1727 Druid Oaks Ne, Atlanta, GA 30329 | 2016-08-01 |
| 1023467768 | Ashley Elliott | Physician Assistant | 59 Executive Park, Atlanta, GA 30329 | 2016-06-03 |
| 1285096115 | Kimberley Fox | Internal Medicine | 1600 Clifton Rd Ne, Ms A-04, Cdc, Atlanta, GA 30329 | 2016-03-21 |
| 1275991648 | Mary Patricia Joyce | Internal Medicine | 1600 Clifton Road, E-47, Centers for Disease Control and Prevention, Atlanta, GA 30329 | 2016-02-01 |
| 1346656618 | Amelia Muniz Hernandez | Pediatrics | 1841 Clifton Rd Ne # 508, Atlanta, GA 30329 | 2014-07-08 |
| Find all providers in zip 30329 | ||||
| Taxonomy Code | 363LN0005X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Neonatal, Critical Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902357866 | Carla Zimmerly | Nurse Practitioner | 1711 Tullie Circle, Atlanta, GA 30329 | 2016-10-17 |
| 1932721461 | Ashley Murry | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2020-05-06 |
| 1881227940 | Ingried Albisu | Nurse Practitioner | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2020-02-18 |
| 1407400427 | Rachel Mae Perlman | Nurse Practitioner | 1584 Tullie Cir Ne, Atlanta, GA 30329-2311 | 2019-07-29 |
| 1669962684 | Hilary Antley Jones | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2018-05-15 |
| 1164935326 | Salina Patel | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2017-11-09 |
| 1508307430 | Blair Derossett | Nurse Practitioner | 1968 Peachtree Rd Nw, Atlanta, GA 30309-1281 | 2017-03-11 |
| 1245779149 | Caitlin Ezzell | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2017-02-13 |
| 1083156848 | Katherine Gruber Stephenson | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-11-10 |
| 1689125023 | Melissa Sue Pichetto | Nurse Practitioner | 1711 Tullie Cir Ne, Atlanta, GA 30329-2305 | 2016-10-20 |
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| 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.