Individual
ISSAIAH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
936 SHARPE HOSPITAL RD, WESTON, WV 26452-8550
(304) 269-1210
Mailing address
PO BOX 12, ENTERPRISE, WV 26568-0012
(304) 709-8420
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
102650
WV
Other
Enumeration date
05/16/2019
Last updated
09/22/2025
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