KRISTINA MARIE WALLACE (NPI# 1417326984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417326984 |
| Entity Type | Individual |
| Full Name | KRISTINA MARIE WALLACE |
| Credential | PA-C |
| Practice Address |
537 Union Ave Second Floor Grants Pass OR 97527-5543 |
| Mailing Address |
1115 Se 164th Ave Dept 358 Vancouver WA 98683-8004 |
| Practice Telephone | 5414796777 |
| Mailing Telephone | 3607291253 |
| Mailing Fax Number | 3607293185 |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA174747 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629498175 | Kristina Marie Wallace | Counselor | 1380 Howard St, San Francisco, CA 94103-2638 | 2014-04-23 |
| Street Address |
537 UNION AVE SECOND FLOOR |
| City | GRANTS PASS |
| State | OR |
| Zip Code | 97527-5543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902832652 | Samuel D. Mcreynolds | Physician Assistant | 537 Union Ave, Grants Pass, OR 97527-5543 | 2006-06-24 |
| 1255976197 | Alisha Naomi Zauher | Nurse Practitioner | 537 Union Ave, Grants Pass, OR 97527 | 2019-11-14 |
| 1023575891 | Kristen Clark | Specialist/Technologist | 537 Union Ave, Grants Pass, OR 97527-5543 | 2019-02-27 |
| 1225516537 | Jessie Kristen Hermant | Nurse Practitioner | 537 Union Ave, Grants Pass, OR 97527-5543 | 2018-07-30 |
| 1760973739 | Taira Coryn Butler | Registered Nurse | 537 Union Ave, Grants Pass, OR 97527 | 2018-05-24 |
| 1073041158 | Courtney Marie Wedgeworth | Otolaryngology | 537 Union Ave, Grants Pass, OR 97527-5543 | 2017-06-01 |
| 1073063772 | Beau J Shelton | Physician Assistant | 537 Union Ave, Grants Pass, OR 97527-5543 | 2016-10-06 |
| 1578918546 | Gabrielle Marie Fey | Registered Nurse | 537 Union Ave, Grants Pass, OR 97527-5543 | 2016-04-27 |
| 1093169104 | App Ent | Otolaryngology | 537 Union Ave, Second Floor -2c, Grants Pass, OR 97527-5543 | 2016-04-15 |
| 1811341928 | App Orthopedic Clinic | Orthopaedic Surgery | 537 Union Ave, Second Floor 2a, Grants Pass, OR 97527-5543 | 2016-04-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528618600 | Sandra J Campos | Technician | 365 Sleepy Hollow Loop, Grants Pass, OR 97527 | 2019-09-19 |
| 1720501026 | Kelly Bates | Massage Therapist | 501 Cheney Creek Rd, Grants Pass, OR 97527 | 2017-07-19 |
| 1740650134 | Sara Brelsford | Nurse Practitioner | 1075 Sw Grandview Avenue, Suite 200, Grants Pass, OR 97527 | 2015-09-29 |
| 1962816348 | Kimberly Hathaway | Counselor | 320 Ramsey Place, Grants Pass, OR 97527 | 2014-06-13 |
| 1801216999 | Christina Ann Marie Schultz | Massage Therapist | 242 Curtis Drive, Grants Pass, OR 97527 | 2014-04-16 |
| 1013343359 | Shaunte Angelique Duron | Counselor | 711 Sw Ramsey Avenue, Grants Pass, OR 97527 | 2013-09-18 |
| 1063848547 | Megan Faye Armstrong | Behavioral Analyst | 715 Ramsey Aveenue, Grants Pass, OR 97527 | 2013-09-17 |
| 1124454608 | Mark Albert Cook | Behavioral Analyst | 1153 Sw Cal Allen Lane, Grants Pass, OR 97527 | 2013-09-17 |
| 1952741969 | Mitchell K Sheeler | Denturist | 1850 Williams Hwy, Grants Pass, OR 97527 | 2013-07-05 |
| 1790038339 | White City Vamc | Clinic/Center | 1877 Williams Highway, Grants Pass, OR 97527 | 2012-10-19 |
| Find all providers in zip 97527 | ||||
| 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 |
|---|---|---|---|---|
| 1548763048 | Jaclyn Loner | Physician Assistant | 1021 Ne 6th St, Grants Pass, OR 97526-1113 | 2018-03-12 |
| 1386762912 | Jonathan Edward Nordheim | Physician Assistant | 625 Sw Ramsey Ave, Grants Pass, OR 97527-5808 | 2007-03-26 |
| 1619590221 | Andrew Mark Tijerina | Physician Assistant | 495 Sw Ramsey Ave, Grants Pass, OR 97527-5681 | 2020-05-19 |
| 1194378232 | Laura Lee Thrasher | Physician Assistant | 1075 Sw Grandview Avenue, Suite 200, Grants Pass, OR 97527 | 2019-07-18 |
| 1891209870 | Carlie Alexandra Grigg | Physician Assistant | 495 Sw Ramsey Ave, Grants Pass, OR 97527-5681 | 2017-11-28 |
| 1073063772 | Beau J Shelton | Physician Assistant | 537 Union Ave, Grants Pass, OR 97527-5543 | 2016-10-06 |
| 1760839328 | Amber Rachael Koonce | Physician Assistant | 1075 Grandview Ave Ste 200, Grants Pass, OR 97527-5118 | 2016-05-24 |
| 1679939102 | Michele Cambron | Physician Assistant | 702 Sw Ramsey Ave, Suite 224, Grants Pass, OR 97527-5858 | 2016-01-13 |
| 1578952537 | Kenneth Durrant | Physician Assistant | 537 Union Ave, Second Floor, 2a, Grants Pass, OR 97527-5543 | 2015-01-14 |
| 1619379815 | Jason Michael Van-brunt | Physician Assistant | 625 Sw Ramsey Ave, Suite A, Grants Pass, OR 97527-5808 | 2014-09-18 |
| Find all providers in GRANTS PASS | ||||
| City | GRANTS PASS |
| Zip Code | 97527 |
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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.