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

William Jacob Wallace, PA

Individual provider Medical Physician Assistant · NPI 1992183412

William Jacob Wallace, PA is a Physician Assistant in Cookeville, Tennessee. Qualified in 2014, 12 years ago. Practices with Campbell Clinic, PC, a 225-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
12
Licensed in
TN
In the registry since
2015
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

105 S Willow Ave
Cookeville, TN 38501-4667
Phone: (931) 372-7716
Fax: (931) 372-0087
Show map & directions

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

Additional practice locations (2)

  • 203 N Cedar Ave, Cookeville, TN 38501 — (931) 528-1992
  • 150 Sam Walton Dr, Sparta, TN 38583-8815 — (931) 739-4000

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA2743 (TN)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 2743 (TN)

Record details

NPI number1992183412
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedMay 16, 2015
Last updated in NPPESAugust 27, 2020
Certification dateAugust 27, 2020
Mailing address203 N Cedar Ave, Cookeville, TN 38501-2498

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Campbell Clinic, Pc — 225 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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