Individual
MR. JAMES KENNETH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
703 E MARSHALL AVE, SUITE 2000, LONGVIEW, TX 75601-5500
(903) 315-5300
(903) 315-5301
Mailing address
195 W 1ST ST, RUSK, TX 75785-1201
(903) 683-2676
(903) 315-5301
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
228579
TX
Other
Enumeration date
08/24/2006
Last updated
06/04/2012
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