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

Jacob Cole Wallace

Individual provider Emergency Registered Nurse · NPI 1710807565

Jacob Cole Wallace is an Emergency Registered Nurse in Odessa, Texas. Practices as a sole proprietor. Licensed in Texas.

Licensed in
TX
In the registry since
2026

Practice location Address checks out

500 W 4th St
Odessa, TX 79761-5059
Phone: (432) 640-4000
Show map & directions

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

Specialties & licences

Emergency Registered Nurse (primary) Taxonomy 163WE0003X · Licence 1160284 (TX)

Record details

NPI number1710807565
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 20, 2026
Last updated in NPPESJuly 20, 2026
Certification dateJuly 20, 2026
Mailing address500 W 4th St, Odessa, TX 79761-5059