Individual
DARCIE L WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6000
Mailing address
PO BOX 180575, SAINT LOUIS, MO 63150-3511
(314) 251-6000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
118539
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1016860
NCCPA CERT #
MO
Enumeration date
07/10/2006
Last updated
10/22/2014
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