Individual
MRS. JORDAN JEHREE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5620 W MARKHAM ST, LITTLE ROCK, AR 72205-3327
(501) 508-7163
(501) 203-9850
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(855) 963-2100
(813) 321-1296
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-1208
AR
363AM0700X
Medical Physician Assistant
Primary
PA-1208
AR
Other
Enumeration date
09/22/2023
Last updated
09/15/2025
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