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GARRETT WALLACE DO
NPI 1992596738
Student in an Organized Health Care Education/Training Program in Tyler, TX

Active since May 13, 2025PECOS Enrolled
11937 US HIGHWAY 271, TYLER, TX 75708(903) 877-7200 Get Directions Write a Review

NPPES record last updated: May 13, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Garrett Wallace Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARRETT WALLACE DO (NPI 1992596738) is an individual student in an organized health care education/training program in Tyler, Texas, licensed in Texas (BP10095005) and active in the NPI registry since May 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1992596738
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameGARRETT WALLACECredential: DO
Location Address11937 US HIGHWAY 271Tyler, TX 75708-3154
Mailing Address11937 Us Highway 271Tyler, TX 75708-3154 · (903) 877-7200
Phone(903) 877-7200
Sole ProprietorNo
Enumeration DateMay 13, 2025
NPPES CertifiedMay 13, 2025
✔ NPI 1992596738 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in TX · BP10095005
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
11937 US HIGHWAY 271, Tyler, TX 75708
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Garrett Wallace Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER
Psychiatric Unit
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7200
TYLER DAVIS DO
Surgery (Trauma Surgery)
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7777
PATRICIA DIANNE SHACKELFORD
Pharmacist
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7088
JENNIFER ANNISA MATHEW DO
Student in an Organized Health Care Education/Training Program
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7200
JASMINE MARIE GAMBOA MD
Student in an Organized Health Care Education/Training Program
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7200
DR. SADIE ROSE WALTER DO
Student in an Organized Health Care Education/Training Program
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7200
RENDALL NORTHCUTT FNP
Nurse Practitioner (Primary Care)
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7200
ES-HAQ SADDELDIN HASSANIN DO
Hospitalist
11937 US HIGHWAY 271
TYLER, TX 75708
Smith County (903) 877-7253

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Garrett Wallace's NPI number?

The NPI number for Garrett Wallace is 1992596738. It was assigned to this individual provider in the NPPES registry on May 13, 2025.

Where is Garrett Wallace located?

Garrett Wallace practices at 11937 Us Highway 271, Tyler, TX 75708. The listed phone number is (903) 877-7200.

What is Garrett Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Garrett Wallace enrolled in Medicare?

Yes. Garrett Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Garrett Wallace was last updated on May 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.