Individual provider · Type 1 NPI

Jesse L. Wallace, AG-ACNP

Acute Care Nurse Practitioner · Charlottesville, VA

NPI number 1013697267 Active

Practice location

500 Martha Jefferson Dr Ste 505
Charlottesville, VA 22911-4668

Call (434) 654-5260 Map

Fax (434) 654-5261

Other practice locations

  • 1215 Lee St, Charlottesville, VA 22908-0816 · (434) 924-3627

Specialties and licenses

TaxonomyCodeLicense
Acute Care Nurse Practitioner Primary 363LA2100X0024187479 (VA)
Critical Care Medicine (Anesthesiology) Physician 207LC0200X0024187479 (VA)

Acute Care Nurse Practitioner: Definition to come...

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About NPI 1013697267

Jesse L. Wallace, AG-ACNP's National Provider Identifier is 1013697267, issued on Jul 24, 2023. The primary taxonomy on file is Acute Care Nurse Practitioner (363LA2100X), and the practice location is in Charlottesville, VA. The record was last updated on May 11, 2026.