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

Lourdes Ivette Wallace, AGACNP-BC

Individual provider Nurse Practitioner · NPI 1659773869

Lourdes Ivette Wallace, AGACNP-BC is a Nurse Practitioner in Boerne, Texas. Works from 2 locations. Licensed in Texas and Utah.

Licensed in
TX, UT
In the registry since
2014
Specialties on file
5

Practice location Address checks out

113 Pleasant Valley Dr Ste 210
Boerne, TX 78006-5683
Phone: (830) 267-4575
Fax: (830) 267-4575
Show map & directions

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

Additional practice locations (1)

  • 10004 Johns Rd, Boerne, TX 78006-8811 — (830) 267-4575

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence AP126548 (TX)
Nurse Practitioner Taxonomy 363L00000X · Licence RN860816 (TX)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence 11670071-4405 (UT)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence AP126548 (TX)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 11670071-4405 (UT)

Record details

NPI number1659773869
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP-BC
Sole proprietorNo
NPI enumeratedSeptember 18, 2014
Last updated in NPPESSeptember 3, 2020
Certification dateSeptember 3, 2020

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