JESSICA LYNN WALLACE (NPI# 1659637478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659637478 |
| Entity Type | Individual |
| Full Name | JESSICA LYNN WALLACE |
| Practice Address |
26652 Muse Road Muse OK 74949 |
| Mailing Address |
Box 26652 St. Hwy. 63 Hodgen OK 74939 |
| Practice Telephone | 9185671719 |
| Mailing Telephone | 9185671719 |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871089680 | Jessica Renee Wallace | Nurse Practitioner | 1821 E. High St., Springfield, OH 45505 | 2018-07-04 |
| 1821517210 | Jessica Wallace | Behavioral Analyst | 43835 Timber Sq Unit 203, Leesburg, VA 20176-3432 | 2017-09-17 |
| 1548639560 | Jessica Ann Wallace | Physician Assistant | 1890 Us Highway 131 Unit 4, Petoskey, MI 49770-8344 | 2015-09-21 |
| 1285031682 | Jessica Wallace | Speech-Language Pathologist | 2900 Knox School Rd, Alliance, OH 44601-9021 | 2014-12-01 |
| 1073940888 | Jessica Wallace | Marriage & Family Therapist | 15611 Pomerado Rd Ste 535, Poway, CA 92064-2437 | 2013-10-11 |
| 1245577907 | Jessica Wallace | Pharmacist | 6175 Hickory Flat Hwy, Suite 140, Canton, GA 30115-7207 | 2013-01-14 |
| 1669751418 | Jessica Leigh Wallace | Physical Therapist | 224 Old River Rd, Bluffton, SC 29909-3952 | 2011-08-11 |
| 1689846164 | Jessica Nicole Wallace | Registered Nurse | 655 Front St, Middleport, OH 45760 | 2008-03-25 |
| 1710507371 | Jessica M Wallace | Nurse Anesthetist, Certified Registered | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-04-23 |
| 1306483359 | Jessica Wallace | Behavior Technician | 3130 S Durango Dr Ste 425, Las Vegas, NV 89117-4455 | 2019-12-09 |
| Street Address |
26652 MUSE ROAD |
| City | MUSE |
| State | OK |
| Zip Code | 74949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902250889 | Misti Mortensen | Driver | 26652 Muse Road, Muse, OK 74949 | 2016-04-18 |
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073623 | Keonte Criswell | Community/Behavioral Health | 11530 Andover Ct, Oklahoma City, OK 73130-8217 | 2020-11-05 |
| 1427656909 | Against All Odds Youth and Family Services | Community/Behavioral Health | 2701 Nw 185th St, Edmond, OK 73012-9795 | 2020-10-15 |
| 1730798117 | Healing Minds Counseling LLC | Community/Behavioral Health | 5300 N Meridian Ave Ste 11, Oklahoma City, OK 73112-2179 | 2020-07-30 |
| 1477170322 | Glostars LLC | Community/Behavioral Health | 19704 Vivace Dr, Edmond, OK 73012-5232 | 2020-06-26 |
| 1780201798 | Canadian County Collaborative LLC | Community/Behavioral Health | 1703 Professional Cir Ste 201, Yukon, OK 73099-6498 | 2020-06-26 |
| 1235754458 | New Life Counseling Center | Community/Behavioral Health | 1206 N Hwy 81, Duncan, OK 73533-1790 | 2020-06-12 |
| 1770108946 | Meadow Hazelhoff Counseling, LLC | Community/Behavioral Health | 9524 Conners Way, Mcloud, OK 74851-8668 | 2020-06-12 |
| 1407477920 | Keetoowah Economic Development | Community/Behavioral Health | 16414 W 760 Rd, Tahlequah, OK 74464-1675 | 2020-05-06 |
| 1992336481 | Share More Ctc, LLC | Community/Behavioral Health | 2000 N Broadway St Ste B, Moore, OK 73160-4416 | 2020-02-03 |
| 1356981138 | Grand Lake Mental Health Center Inc | Community/Behavioral Health | 2225 N Union, Ponca City, OK 74601-1536 | 2020-01-09 |
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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.