MS. Donetta Wallace, P.A.-C

NPI #1417958828 in Paintsville, Kentucky

Provider Information

NPI Number: 1417958828
Entity Type: Individual
Name: MS. Donetta Wallace, P.A.-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: P.A.-C
Enumeration Date: Aug 9, 2005
Last Updated: Feb 1, 2022

Practice Location

Address: 336 N MAYO TRL
City: Paintsville
State: Kentucky
ZIP Code: 41240-1804
Phone: (606) 789-8666

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant - Medical — Medical	363AM0700X
Physician Assistant	363A00000X	Primary

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