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General NPI Number Information
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NPI Number | 1972322212
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Entity Type | Organization
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Legal Business Name | CARLA WALLACE NURSE PRACTITIONER, PLLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 2421 COPPER SKY DR
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City | PEARLAND
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State | TX
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Zip | 77584-3782
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Country | US
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Telephone | 409-350-0016
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Fax | 877-673-2947
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Provider Business Mailing Address
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Address Line | 2421 COPPER SKY DR
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City | PEARLAND
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State | TX
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Zip | 77584-3782
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Country | US
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Telephone | 409-350-0016
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLA WALLACE
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Credential | GNP
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Telephone | 409-350-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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