Carla Wallace Nurse Practitioner, PLLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

CARLA WALLACE NURSE PRACTITIONER, PLLC

Practice address

2421 Copper Sky Dr
Pearland, TX 77584-3782

Phone

(409) 350-0016

Fax

(877) 673-2947

NPI assigned

Oct 4, 2024

Organization subpart

No

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

Authorized official

Name

Carla Wallace, GNPNPI 1164122149

Title

Owner

Phone

(409) 350-0016

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carla Dennise Wallace, A-GNP-C

  • Gerontology Nurse Practitioner
  • Pearland, TX
  • NPI 1164122149
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771545600000",
    "number": "1972322212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 COPPER SKY DR",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775843782",
            "telephone_number": "409-350-0016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 COPPER SKY DR",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775843782",
            "telephone_number": "409-350-0016",
            "fax_number": "877-673-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLA WALLACE NURSE PRACTITIONER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-04",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-350-0016",
        "authorized_official_credential": "GNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Lee Carlile, SLPA
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• Alvaro A Carpio, DDS

• Adult Health Nurse Practitioner in Pearland, TX
• Providers in Pearland, TX by specialty
• Adult Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.