JESSICA ANN WALLACE (NPI# 1548639560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548639560 |
| Entity Type | Individual |
| Full Name | JESSICA ANN WALLACE |
| Credential | PA-C |
| Practice Address |
1890 Us Highway 131 Unit 4 Petoskey MI 49770-8344 |
| Mailing Address |
116 W Mitchell Petoskey MI 49770-2357 |
| Practice Telephone | 2314872000 |
| Mailing Telephone | 2313482828 |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601007439 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1548639560 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 37450 Dequindre Rd, Sterling Heights, MI 483103503 | 5869795100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871089680 | Jessica Renee Wallace | Nurse Practitioner | 1821 E. High St., Springfield, OH 45505 | 2018-07-04 |
| 1821517210 | Jessica Wallace | Behavioral Analyst | 43835 Timber Sq Unit 203, Leesburg, VA 20176-3432 | 2017-09-17 |
| 1285031682 | Jessica Wallace | Speech-Language Pathologist | 2900 Knox School Rd, Alliance, OH 44601-9021 | 2014-12-01 |
| 1073940888 | Jessica Wallace | Marriage & Family Therapist | 15611 Pomerado Rd Ste 535, Poway, CA 92064-2437 | 2013-10-11 |
| 1245577907 | Jessica Wallace | Pharmacist | 6175 Hickory Flat Hwy, Suite 140, Canton, GA 30115-7207 | 2013-01-14 |
| 1659637478 | Jessica Lynn Wallace | Community/Behavioral Health | 26652 Muse Road, Muse, OK 74949 | 2012-04-05 |
| 1669751418 | Jessica Leigh Wallace | Physical Therapist | 224 Old River Rd, Bluffton, SC 29909-3952 | 2011-08-11 |
| 1689846164 | Jessica Nicole Wallace | Registered Nurse | 655 Front St, Middleport, OH 45760 | 2008-03-25 |
| 1710507371 | Jessica M Wallace | Nurse Anesthetist, Certified Registered | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-04-23 |
| 1306483359 | Jessica Wallace | Behavior Technician | 3130 S Durango Dr Ste 425, Las Vegas, NV 89117-4455 | 2019-12-09 |
| Street Address |
1890 US HIGHWAY 131 UNIT 4 |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-8344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801081344 | Nicole Elizabeth Rataj Casady | Physician Assistant | 4170 Cedar Bluff Dr, Petoskey, MI 49770-7627 | 2007-09-07 |
| 1659438976 | Patricia Elizabeth Kelly | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2007-01-03 |
| 1447350855 | Kurt B Anderson | Physician Assistant | 3280 Woods Way Ste 1, Petoskey, MI 49770-8105 | 2006-09-25 |
| 1295074128 | Lindsay Ann Potts | Physician Assistant | 560 W Mitchell St, Suite 505, Petoskey, MI 49770-2275 | 2013-02-13 |
| 1336456102 | Ryan Planck | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2010-09-01 |
| 1447573126 | Rebecca L. Price | Physician Assistant | 560 W Mitchell St, Suite 400, Petoskey, MI 49770-2275 | 2010-03-09 |
| 1518114800 | Adam Richard Wilson | Physician Assistant | 2375 Summit Park Dr, Petoskey, MI 49770-8685 | 2008-08-19 |
| 1346406592 | Courtney Griffith-sumpter | Physician Assistant | 116 W Mitchell St, Petoskey, MI 49770-2324 | 2008-08-06 |
| 1568559383 | Sarah A Adams | Physician Assistant | 560 W Mitchell St, Suite 400, Petoskey, MI 49770-2275 | 2006-10-05 |
| 1053338830 | Kenneth Adams Crockett Jr. | Physician Assistant | 1890 S Us Highway 131, Suite 4, Petoskey, MI 49770-8344 | 2006-07-16 |
| Find all providers in PETOSKEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.