Provider Demographics
NPI:1861371742
Name:WACKER, JAMES (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WACKER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 SANDHURST LN APT D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4731
Mailing Address - Country:US
Mailing Address - Phone:619-573-3038
Mailing Address - Fax:
Practice Address - Street 1:6007 SANDHURST LN APT D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4731
Practice Address - Country:US
Practice Address - Phone:619-573-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210753363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health