Jason David Wallace

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

125806 Issued in AR

Practice address

2214 Chesapeake CV
Jonesboro, AR 72404-7104

Phone

(615) 618-6200

NPI assigned

Jun 22, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Bernards Hospital Inc.Group PAC ID 0941105480, 187 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

89.72 of 100Reported as apm

Quality

72.97

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Bernards Hospital, Inc

  • Obstetrics Physician
  • Jonesboro, AR
  • NPI 1518327287
  Medicare reassignment Care Compare group NPD
• Behavioral Medicine Associates, LLC

  • Psychiatry Physician
  • Searcy, AR
  • NPI 1356406276
  Medicare reassignment NPD
• Delta Behavioral Health, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manila, AR
  • NPI 1720637085
  Medicare reassignment NPD
• Supportive Psych Care of Arkansas PA

  • Psychiatry Physician
  • Siloam Springs, AR
  • NPI 1437887437
  Medicare reassignment NPD
• CS Pacs 3 Southwest, LLC

  • Hospitalist Physician
  • Baytown, TX
  • NPI 1275398430

  AR

  Medicare reassignment NPD
• Ipc Pac Healthcare Services of Missouri Inc

  • Hospitalist Physician
  • Sikeston, MO
  • NPI 1326497587

  AR

  Medicare reassignment NPD
• Renew Mental Health and Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jonesboro, AR
  • NPI 1447817572
  Medicare reassignment
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809

  AR

  Medicare reassignment
• St Bernards Hospital Inc

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1346301306
  NPD
• St Bernards Hospital Inc.

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1396053096
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1235755638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 GALLAWAY CV",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724047827",
            "telephone_number": "615-618-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2214 CHESAPEAKE CV",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724047104",
            "telephone_number": "615-618-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JASON",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-22",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "125806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Wallace
• Aubrey Wallace
• Brooke Wallace, COTA/L
• Feliece Wallace
• Gregory Wallace
• Latoya Wallace
• Pamela Wallace
• Patti Wallace
• Willie Wallace
• Angel Wallis, LPC

• Psychiatric/Mental Health Nurse Practitioner in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.