Mrs. Jordan J. Wallace PA-C - Medical Physician Assistant in Little Rock, Arkansas | ProviderWire

Full Name

Mrs. Jordan Jehree Wallace PA-C

NPI Number

1063291789

NPI Type

Individual Provider

Gender

Female

Enumeration Date

09/22/2023

Specialties

(Taxonomies)

Name

Medical Physician Assistant

Code

363AM0700X

Primary Taxonomy

Yes

Licenses

State

Arkansas

License Number

PA-1208

Contact
Information

Purpose

Mailing

Location

Address

4301 W MARKHAM ST # 783

4301 W MARKHAM ST # 721

City

Little Rock

Little Rock

State

AR

AR

Postal Code

72205-7101

72205-7101

Country

US

US

Telephone Number

(501) 686-8000

(501) 526-6062

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 11/02/2023

Provider Address

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