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

Marty Dale Wallace, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1164674743

Marty Dale Wallace, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Johnson City, Tennessee. Qualified in 2008, 18 years ago. Practices with Huntsville Hospital Anesthesia, a 158-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
18
Licensed in
TN
In the registry since
2008
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1114 Sunset Dr Ste 4
Johnson City, TN 37604-2969
Phone: (423) 283-0776
Fax: (423) 283-0549
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence APN13700 (TN)

Record details

NPI number1164674743
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedOctober 15, 2008
Last updated in NPPESNovember 20, 2009

Medicare enrollment

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

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Huntsville Hospital Anesthesia — 158 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Johnson City