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NPI Code Detail

MEDICARE: JESSICA FAYE WALLACE PA-C

MEDICARE: JESSICA FAYE WALLACE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant0010-00640NC

General Provider Information

NPI Number : 1306920780
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA FAYE WALLACE PA-C
Provider Business Mailing Address
First Line : 3020 14TH ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20009-6865
Country : US
Telephone Number : 202-745-4300
Fax Number : 202-745-2510
Provider Business Practice Location Address
First Line : 3020 14TH ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20009-6865
Country : US
Telephone Number : 202-745-4300
Fax Number : 202-745-2510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 03/26/2021

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Directions to “ JESSICA FAYE WALLACE PA-C” Practice Location

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