Individual
MR. JOSHUA TAYLOR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
4301 W MARKHAM ST # 783, LITTLE ROCK, AR 72205-7101
(501) 686-8000
(501) 526-2000
Mailing address
273 CINEL LOOP, AUSTIN, AR 72007-8790
(870) 692-1906
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
A005500
AR
363LF0000X
Family Nurse Practitioner
Primary
A005500
AR
Other
Enumeration date
02/07/2018
Last updated
04/10/2020
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