Individual provider · Type 1 NPI

Darcie L. Wallace, PA-C

Surgical Physician Assistant · St. Louis, MO

NPI number 1083648489 Active

Practice location

615 S New Ballas Rd
St. Louis, MO 63141-8221

Call (314) 251-6000 Map

Mailing address

PO Box 180575
St. Louis, MO 63150-3511

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X118539 (MO)

Surgical Physician Assistant: Definition to come...

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About NPI 1083648489

Darcie L. Wallace, PA-C's National Provider Identifier is 1083648489, issued on Jul 10, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in St. Louis, MO. The record was last updated on Oct 22, 2014.