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Contact Information

JARED L WALLACE, PA-C
43783 KENAI SPUR HWY
KENAI, AK99611
 Phone: 907-283-9116
 Fax: 907-283-9122
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JARED L WALLACE · (Male)

NPI Number 1063746667
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 09/29/2009
Last updated 03/07/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • AK Medicaid 1020379
Hospital affiliation(s)
  • CENTRAL PENINSULA GENERAL HOSPITAL - (Acute Care)
    250 HOSPITAL PLACE
    SOLDOTNA, AK 99669
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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