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General NPI Number Information
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NPI Number | 1457952558
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Entity Type | Individual
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Provider Name | JESSICA L WALLER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 2510 CROCKETT DR STE A
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City | BROWNWOOD
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State | TX
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Zip | 76801-5928
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Country | US
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Telephone | 325-794-5444
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Fax | 325-794-5346
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Provider Business Mailing Address
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Address Line | 1665 ANTILLEY RD STE 300
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City | ABILENE
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State | TX
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Zip | 79606-5277
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Country | US
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Telephone | 325-437-8655
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Fax | 325-437-8647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1018050
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License Number State | TX
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