CHARLES EARL WALL JR. (NPI# 1013178128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013178128 |
| Entity Type | Individual |
| Full Name | CHARLES EARL WALL JR. |
| Credential | PA-C |
| Practice Address |
1100 N College Ave Fayetteville AR 72703-1944 |
| Practice Telephone | 4794434301 |
| Mailing Telephone | 4794434301 |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2016-07-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1143 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | DEA | MW1783681 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376985655 | Charles Coleman Wall | Dentist | 2200 E 4500 S, Suite 240, Salt Lake City, UT 84117-4437 | 2013-07-26 |
| 1073717955 | Charles Edward Wall Jr. | Surgery | 102 Doctors Park, Starkville, MS 39759 | 2007-06-13 |
| 1770792871 | Charles Ray Wall | Pharmacist | 727 Memorial Dr, Bessemer, AL 35022-6029 | 2007-05-22 |
| 1164528725 | Charles A. Wall | Surgery | 455 Grand Ave, South San Francisco, CA 94080-3635 | 2006-09-14 |
| Street Address |
1100 N COLLEGE AVE |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-1944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265435697 | Randall B Davis | Specialist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2005-05-31 |
| 1548870462 | Anna Parker | Pharmacist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-08-05 |
| 1912522095 | Shan M Khan | Dentist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-06-14 |
| 1760003495 | Andrea G. Burnett | Respiratory Therapist, Registered | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-05-05 |
| 1396366092 | Robin Elizabeth Bush | Respiratory Therapist, Registered | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-05-04 |
| 1295356186 | Brock Helfrich | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1999 | 2020-05-01 |
| 1285255661 | Curtis Deon Burnley Jr. | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-27 |
| 1871113878 | Katherine Lynn Horn | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-20 |
| 1649890930 | William Colton Cheek | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-16 |
| 1487285995 | Kristen Schatzman | Social Worker | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443387 | Melissa Macneil Spencer | Physician Assistant | 810 Knighthood Cir, Fayetteville, NY 13066-8721 | 2020-10-03 |
| 1366067548 | Prathna Raval | Physician Assistant | 6808 Thames Dr, Fayetteville, NC 28306-2524 | 2020-06-12 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1144858515 | Mackenzie Anna Kirchner | Physician Assistant | 568 Sandy Creek Rd, Fayetteville, GA 30214-4205 | 2020-03-31 |
| 1770116931 | Chasity Nicole Sullivan | Physician Assistant | 202b Highland Ave, Fayetteville, NC 28305-5308 | 2020-02-17 |
| 1740812833 | Madeline Everitt Monday | Physician Assistant | 705 Stonington Dr, Fayetteville, NC 28311-0329 | 2020-02-07 |
| 1396375325 | Lisa Ann Gross | Physician Assistant | 3007 Town Center Dr Ste 100, Fayetteville, NC 28306-3663 | 2020-01-17 |
| 1811536048 | Kelly Hamilton Sweatt | Physician Assistant | 1991 Fordham Dr Ste 200, Fayetteville, NC 28304-3774 | 2020-01-06 |
| 1922563667 | Reandy Nicole Hearn | Physician Assistant | 2911 Breezewood Ave Ste 100, Fayetteville, NC 28303-5464 | 2019-02-06 |
| 1790259430 | Cassandra Ann Nebosky-diaz | Physician Assistant | 659 Daharan Dr, Fayetteville, NC 28314-6538 | 2019-01-16 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
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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.