Individual
MS. MOLLEE JOHANSEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3537 S INTERSTATE 35 E, DENTON, TX 76210-6800
(214) 851-1777
(855) 576-4130
Mailing address
3537 S I 35 E STE 320B, DENTON, TX 76210-6800
(214) 851-1777
(855) 576-4130
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA02519
TX
363AM0700X
Medical Physician Assistant
Primary
PA02159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02519
LICENSE
TX
Enumeration date
11/28/2007
Last updated
09/23/2025
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