IndividualActive
Issaiah Wallace, PMHNP
NPI 1508422338 · Psychiatric/Mental Health Nurse Practitioner · Weston, WV
Provider details
- NPI number
- 1508422338
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PMHNP
- Sex
- Male
- Sole proprietor
- No
- License
- 102650 (WV)
Mailing address
Po Box 12
Enterprise, WV 26568-0012
Registry dates
- Enumerated
- 2019-05-16
- Last updated
- 2025-09-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.