Organization
ODYSSEY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED LEE WALLACE PA-C (OWNER)
(907) 313-4569
Entity
Organization
Contact information
Practice address
11595 KENAI SPUR HIGHWAY, KENAI, AK 99611
(907) 313-4569
(907) 313-4939
Mailing address
PO BOX 922, KASILOF, AK 99610-0922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
03/06/2019
Last updated
12/01/2025
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