JEFFREY W WALLACE (NPI# 1649479171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649479171 |
| Entity Type | Individual |
| Full Name | JEFFREY W WALLACE |
| Credential | PA-C |
| Practice Address |
112 Piper Hill Dr First Floor Saint Peters MO 63376-1690 |
| Practice Telephone | 6364413444 |
| Practice Fax Number | 6364419832 |
| Mailing Telephone | 6364413444 |
| Mailing Fax Number | 6364419832 |
| Enumeration Date | 2007-07-14 |
| Last Update Date | 2007-07-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
2005024101 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
2005024101 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | LICENSE | 2005024101 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629089156 | Jeffrey S Wallace | Orthopaedic Surgery | 6800 Heritage Pkwy Ste 102, Rockwall, TX 75087-8746 | 2006-08-10 |
| 1821014838 | Jeffrey W Wallace | Dentist | 74 Grafton Rd, Townshend, VT 05353-0262 | 2006-07-14 |
| 1568499234 | Jeffrey A. Wallace I | Pharmacist | 5420 Lancaster Dr, Kaiser Permanente Pharmacy Administration, Brooklyn Heights, OH 44131-1832 | 2006-06-27 |
| 1679563928 | Jeffrey David Wallace | Chiropractor | 820 Charlevoix Dr, Suite 210, Grand Ledge, MI 48837-8188 | 2005-10-27 |
| 1548262108 | Jeffrey Leigh Wallace | Preventive Medicine | 411 N Section St, Fairhope, AL 36532-2649 | 2005-08-12 |
| 1538557012 | Jeffrey Eugene Wallace | Counselor | 400 S Jefferson St Ste 200, Spokane, WA 99204-3143 | 2015-01-06 |
| 1619392974 | Jeffrey Michael Wallace | Physician Assistant | 600 Caisson Hill Rd, Fort Riley, KS 66442-7037 | 2014-02-24 |
| 1306006796 | Jeffrey Robert Wallace | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne, Building B Suite 2300, Atlanta, GA 30322-1013 | 2008-06-10 |
| 1215027990 | Jeffrey Wallace | Internal Medicine | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2006-10-13 |
| 1003866419 | Jeffrey Neil Wallace | Chiropractor | 330 140 Village Rd, Unit 9a, Westminster, MD 21157-6127 | 2006-05-10 |
| Street Address |
112 PIPER HILL DR FIRST FLOOR |
| City | SAINT PETERS |
| State | MO |
| Zip Code | 63376-1690 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528041696 | Laura C Horn | Emergency Medicine | 112 Piper Hill Dr, Suite 9, Saint Peters, MO 63376-1690 | 2005-11-22 |
| 1437603263 | Laura T Schmidt | Nurse Practitioner | 112 Piper Hill Dr, Suite 9, Saint Peters, MO 63376-1690 | 2016-08-10 |
| 1952783227 | Sarah R Lavy | Nurse Practitioner | 112 Piper Hill Dr, Ste 12, Saint Peters, MO 63376-1690 | 2015-06-23 |
| 1548663131 | Sarah Lohse | Specialist/Technologist | 112 Piper Hill Dr, Suite 2, Saint Peters, MO 63376-1690 | 2014-09-27 |
| 1780015701 | Matthew Anthony Pliske | Physician Assistant | 112 Piper Hill Dr, Suite 9, Saint Peters, MO 63376-1690 | 2013-12-01 |
| 1326335019 | Imaging Partners of St. Peters, LLC | Clinic/Center | 112 Piper Hill Dr, Suite 5, Saint Peters, MO 63376-1690 | 2011-07-01 |
| 1780978403 | Babar Enterprises LLC | Physical Therapist | 112 Piper Hill Dr, Suite 2, Saint Peters, MO 63376-1690 | 2011-05-31 |
| 1467602680 | Piper Spine Care, PC | Orthopaedic Surgery | 112 Piper Hill Dr, Ste 6, Saint Peters, MO 63376-1690 | 2008-09-24 |
| 1225182157 | St Peters Bone & Joint Surgery Inc | Orthopaedic Surgery | 112 Piper Hill Dr, Suite 9, Saint Peters, MO 63376-1690 | 2007-01-22 |
| 1417015827 | Timothy G Graven | Orthopaedic Surgery | 112 Piper Hill Dr, Saint Peters, MO 63376-1690 | 2006-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275047946 | Nicholas Christian Schultz | Dentist | 100 Piper Hill Dr Ste A, Saint Peters, MO 63376 | 2017-11-16 |
| 1982120093 | Carol Weber | Speech-Language Pathologist | 166 Boone Hills Dr., St Peters, MO 63376 | 2017-08-21 |
| 1619424744 | Forefront Dermatology, S.c. | Dermatology | 5700 Mexico Rd, Suite 14, Saint Peters, MO 63376 | 2016-09-07 |
| 1508310632 | Preferred Family Healthcare, Inc. | Counselor | 2120 Parkway Dr, Saint Peters, MO 63376 | 2016-08-05 |
| 1598130676 | Delta Center Personal Attendant Services | In Home Supportive Care | 3833 Mcclay, Suite 61, St. Peters, MO 63376 | 2015-12-01 |
| 1427420314 | Barbara Marlene Edelman | Counselor | 1286 Jungerman Rd. Suite G, St. Peters, MO 63376 | 2015-10-30 |
| 1255740247 | Claire Williams | Dentist | 340 Mid Rivers Mall Drive, Suite E, St. Peters, MO 63376 | 2014-08-05 |
| 1184042855 | Keith Wickenhauser | Internal Medicine | 201 Bjc Saint Peters Dr Ste 100, Saint Peters, MO 63376 | 2014-03-31 |
| 1821415233 | Abby Link | Physician Assistant | 107 Piper Parkway, #150, St. Peters, MO 63376 | 2014-03-24 |
| 1225452105 | Ashley Gagel | Physical Therapist | 7055 Mexico Rd Suite 1601, St. Peters, MO 63376 | 2014-02-12 |
| Find all providers in zip 63376 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871550921 | David Kevin Winchell | Physician Assistant | 5700 Mexico Rd Ste 14, Saint Peters, MO 63376 | 2006-05-01 |
| 1336130533 | Keith Krause | Physician Assistant | 10 Hospital Dr, Saint Peters, MO 63376-1659 | 2005-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922628528 | Sarah Benson | Physician Assistant | 26791 Andrews Ln, Warrenton, MO 63383-6240 | 2020-04-23 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1912538752 | Karen Anghel | Physician Assistant | 804 S Kisner Dr, Independence, MO 64056-3062 | 2020-01-30 |
| 1457822082 | Jwan Alallaf | Physician Assistant | 4121 Roanoke Rd Apt 18, Kansas City, MO 64111-4053 | 2018-12-07 |
| 1730602921 | Saurav N Kayastha | Physician Assistant | 13013 Fuller Ave Ste A, Grandview, MO 64030-2687 | 2017-07-19 |
| 1891227393 | Hollis Smith | Physician Assistant | 2015 Maplewood Commons Dr, Saint Louis, MO 63143-1003 | 2017-04-03 |
| 1992165104 | Cassie Mcgee | Physician Assistant | 1051 Jones St, Kennett, MO 63857-3866 | 2016-03-01 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| 1699084814 | Travis James Weiss | Physician Assistant | 6724 State Highway 77, Benton, MO 63736-8238 | 2010-10-05 |
| 1235453150 | James F Patton | Physician Assistant | 913 South St, Stockton, MO 65785-9381 | 2010-03-22 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PETERS |
| Zip Code | 63376 |
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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.