Jessica Crosby Waller, MSCN

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

Practice address

2329 Oak Aly
Tyler, TX 75703-5875

Phone

(469) 939-2266

NPI assigned

Jan 12, 2024

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1528839073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8515 RADCLIFFE DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035218",
            "telephone_number": "469-939-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2329 OAK ALY",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035875",
            "telephone_number": "469-939-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JESSICA",
        "middle_name": "CROSBY",
        "name_prefix": "Mrs.",
        "credential": "MSCN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Shawn Wallace, PHARMACIST
• Naomi Susan Wallace, NP
• Richard James Wallace Jr., MD
• Tina Gayle Wallace
• William R Wallace, MD
• Chelsea Walling, LMFT ASSOCIATE
• Stephen Walling, MD
• Reagan Walls, MSN, APRN, FNP-C
• Ellen Stockton Walraven, M.D.
• Mark J. Walsh, D.M.D.

• Nutrition Education Nutritionist in Tyler, TX
• Providers in Tyler, TX by specialty
• Nutrition Education Nutritionist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.