Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brian Wallace, NP

Individual provider Primary Care Nurse Practitioner · NPI 1457561615

Brian Wallace, NP is a Nurse Practitioner in Tyler, Texas. Qualified in 2007, 19 years ago. Practices with Intermountain Medical Group Denver LLC, a 567-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Colorado.

Years since qualifying
19
Licensed in
CO
In the registry since
2007
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

See every abbreviation used in this directory →

Practice location Address checks out

1910 Roseland Blvd
Tyler, TX 75701-4246
Phone: (903) 533-0644
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence RN 169685C (CO)

Record details

NPI number1457561615
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorNo
NPI enumeratedMay 23, 2007
Last updated in NPPESMarch 12, 2010
Mailing address1910 Roseland Blvd, Tyler, TX 75701-4246

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Intermountain Medical Group Denver Llc — 567 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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