Jacob Wallace, APRN
Jacob Wallace, APRN is a Nurse Practitioner in Logan, Utah. Qualified in 2024, 2 years ago. Practices with Southwest Spine and Pain Care Specialists LLC, a 42-clinician group and accepts Medicare assignment. Licensed in Utah.
- Years since qualifying
- 2
- Licensed in
- UT
- In the registry since
- 2024
- Specialties on file
- 2
What do these letters mean?
- APRN — Advanced Practice Registered Nurse
- The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.
Practice location Address checks out
630 E 1400 N Ste 135Logan, UT 84341-2549
Phone: (435) 787-8146
Fax: (435) 787-8149
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Family Nurse Practitioner (primary) | Taxonomy 363LF0000X · Licence 7205712-4405 (UT) |
|---|---|
| Gerontology Nurse Practitioner | Taxonomy 363LG0600X · Licence 7205712-4405 (UT) |
Record details
| NPI number | 1639915911 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | APRN |
| Sole proprietor | Yes |
| NPI enumerated | July 5, 2024 |
| Last updated in NPPES | August 23, 2024 |
| Certification date | August 23, 2024 |
| Mailing address | Po Box 912042, St George, UT 84791-2042 |
Medicare enrollment
| Medicare specialty | NURSE PRACTITIONER |
|---|---|
| Medical school | OTHER |
| Graduated | 2024 (2 years in practice) |
| Group practice | Southwest Spine And Pain Care Specialists Llc — 42 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
Other providers in Logan
-
Mr. Matthew R Harvey, NP-C
630 E 1400 N Ste 135, Logan, UT 84341-2549 · (435) 787-8146