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

Jesse L Wallace, AG-ACNP

Individual provider Acute Care Nurse Practitioner · NPI 1013697267

Jesse L Wallace, AG-ACNP is a Nurse Practitioner in Charlottesville, Virginia. Qualified in 2023, 3 years ago. Practices with University of Virginia Physicians Group, a 1,667-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
3
Licensed in
VA
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

500 Martha Jefferson Dr Ste 505
Charlottesville, VA 22911-4668
Phone: (434) 654-5260
Fax: (434) 654-5261
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1215 Lee St, Charlottesville, VA 22908-0816 — (434) 924-3627

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 0024187479 (VA)
Critical Care Medicine (Anesthesiology) Physician Taxonomy 207LC0200X · Licence 0024187479 (VA)

Record details

NPI number1013697267
Entity typeIndividual (Type 1)
GenderMale
Credentials AG-ACNP
Sole proprietorNo
NPI enumeratedJuly 24, 2023
Last updated in NPPESMay 11, 2026
Certification dateMay 11, 2026
Mailing address500 Martha Jefferson Dr Ste 505, Charlottesville, VA 22911-4668

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice University Of Virginia Physicians Group — 1667 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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