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

MS. Jessica Elizabeth Wallace, NURSEPRACTITIONER

Individual provider Registered Nurse · NPI 1215981170

MS. Jessica Elizabeth Wallace, NURSEPRACTITIONER is a Nurse Practitioner in Manhattan Beach, California. Qualified in 1997, 29 years ago. Practices with Martin Luther King Jr Community Medical Foundation, a 191-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
29
Licensed in
CA
In the registry since
2006
Specialties on file
2
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Practice location Address checks out

2200 N Sepulveda Blvd
Manhattan Beach, CA 90266-2910
Phone: (310) 802-0200
Fax: (310) 794-9035
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1245 16th St Ste 110, Santa Monica, CA 90404-1240 — (310) 319-4033

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 547962 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 10241 (CA)

Record details

NPI number1215981170
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedMay 22, 2006
Last updated in NPPESDecember 19, 2019
Certification dateDecember 19, 2019

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Martin Luther King Jr Community Medical Foundation — 191 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Manhattan Beach