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NPI Code Detail

MEDICARE: JEANNINE M WALLACE P.A.-C

MEDICARE: JEANNINE M WALLACE P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA00446TX

General Provider Information

NPI Number : 1457378051
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE M WALLACE P.A.-C
Provider Business Mailing Address
First Line : 11511 SHADOW CREEK PKWY
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7298
Country : US
Telephone Number : 713-442-0000
Fax Number :
Provider Business Practice Location Address
First Line : 929 GESSNER RD STE 2450
Second Line :
City : HOUSTON
State : TX
Zip : 77024-2593
Country : US
Telephone Number : 713-464-9939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 12/11/2025

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Directions to “ JEANNINE M WALLACE P.A.-C” Practice Location

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