Individual
KIMBERLY S. WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
6496 E STATE ROUTE 69, PRESCOTT VALLEY, AZ 86314-2920
(928) 775-9007
(928) 775-9048
Mailing address
3191 STILLWATER DR, SUITE B, PRESCOTT, AZ 86305-7143
(928) 445-7085
(928) 445-7095
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5775
AZ
Other
Enumeration date
08/08/2006
Last updated
09/09/2014
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