Jacob Cole Wallace

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

1160284 Issued in TX

Practice address

500 W 4TH St
Odessa, TX 79761-5059

Phone

(432) 640-4000

NPI assigned

Jul 20, 2026

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

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": "1784505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1710807565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W 4TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615059",
            "telephone_number": "432-631-2406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W 4TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797615059",
            "telephone_number": "432-640-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACOB",
        "middle_name": "COLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-07-20",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Emergency",
            "state": "TX",
            "license": "1160284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Ann Wall-Trotter, LOT
• Cynthia Jean Wall, PSY.D.
• Vik Wall, MD
• Cristina Marie Wallace Huff, M.D.
• Harold Wayne Wallace, LPC
• Christine W Wan, M.D.
• Yi-Zarn Wang, MD
• Tabitha Wangui
• Gary S Ward, PT
• Robin Lynn Ward, M.S.CCC.A

• Emergency Registered Nurse in Odessa, TX
• Providers in Odessa, TX by specialty
• Emergency Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.