Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JEFFREY W WALLACE, PA-C
ActiveJEFFREY W WALLACE, PA-C is a Physician Assistant healthcare provider located in WENTZVILLE, Missouri. NPI 1649479171 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · WENTZVILLE, MO
Registration Details
- NPI Number
- 1649479171
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 14, 2007 (19.054664165132 yrs)
- Last Updated
- Jul 24, 2025
- Licenses
-
2005024101 (MO)2005024101 (MO)2005024101 (MO)
Practice Information
- Address
-
1601 WENTZVILLE PKWY STE 117WENTZVILLE, MO, 633853814Browse MO providers · Browse ZIP 63385
- Phone
- 6363328477
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Surgical Physician Assistant
- Additional Specialty
- Physician Assistant
Other Physician Assistant Providers in WENTZVILLE, MO
| Name | Credential | NPI |
|---|---|---|
| MS. DAWN M CALABRESE | PA-C | 1114971983 |
| JACQUELINE SOVA CASTAGNO | PA-C | 1073852885 |
| MRS. CORALIA ILINCA LEYDERMAN | PA-C | 1124426812 |
| ANDREW G WEGENER | PA-C | 1760860209 |
| MR. JOSEPH EDWARD SCOTT | PA | 1245752211 |
| MATTHEW SOTHERAN | PA-C | 1336788090 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.