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

Scott David Wallace, NP

Individual provider Family Nurse Practitioner · NPI 1790442408

Scott David Wallace, NP is a Nurse Practitioner in Fairfield, California. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2021
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

See every abbreviation used in this directory →

Practice location Address checks out

513 Silverado Cir
Fairfield, CA 94534-6818
Phone: (707) 864-3240
Show map & directions

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

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 459083 (CA)

Record details

NPI number1790442408
Entity typeIndividual (Type 1)
GenderMale
Credentials NP
Sole proprietorYes
NPI enumeratedNovember 17, 2021
Last updated in NPPESNovember 17, 2021
Certification dateNovember 17, 2021
Mailing address513 Silverado Cir, Fairfield, CA 94534-6818

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)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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