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

Mr. Jason David Wallace

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1235755638

Mr. Jason David Wallace is a Nurse Practitioner in Jonesboro, Arkansas. Qualified in 2019, 7 years ago. Practices with St Bernards Hospital Inc, a 185-clinician group and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
7
Licensed in
AR
In the registry since
2020

Practice location Address checks out

2214 Chesapeake Cv
Jonesboro, AR 72404-7104
Phone: (615) 618-6200
Show map & directions

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

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 125806 (AR)

Record details

NPI number1235755638
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 22, 2020
Last updated in NPPESMay 14, 2025
Certification dateMay 14, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice St Bernards Hospital Inc. — 185 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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