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Connie Sue Wallace, PA-C
Physician Assistant in Huntersville, North Carolina
NPI 1619179132

Connie Sue Wallace is a Physician Assistant based in Charlotte, NC. Connie Sue Wallace practices in Huntersville, NC and has the professional credentials of PA-C. The NPI Number for Connie Sue Wallace is 1619179132 and holds a License No. 102472 (North Carolina).

The current practice location address for Connie Sue Wallace is 10030 Gilead Rd Ste 201, Huntersville, NC and can be reached out via phone at 704-887-4530 and via fax at 704-887-4531. You can also correspond with Connie Sue Wallace through the mailing address at PO BOX 60447, CHARLOTTE, NC - 28260-0447 (mailing address contact number: 704-384-5043).

Location: 10030 Gilead Rd Ste 201, Huntersville, NC, 28260-0447
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619179132
Provider Name
Connie Sue Wallace
Credential
PA-C
Provider Entity Type
Individual
Gender
Female
Address
10030 Gilead Rd Ste 201, Huntersville, NC, 28260-0447
Phone Number
704-887-4530
Fax Number
704-887-4531
Provider Enumeration Date
06/05/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2747736E 01 NC MEDICARE PTAN
8101076 05 NC
159XJ 01 NC BCBS
institution
Provider Business Practice Location Address Details
Address
10030 Gilead Rd Ste 201
City
Huntersville
State
North Carolina
Zip
28078-7545
Phone Number
704-887-4530
Fax Number
704-887-4531
person
Provider Business Mailing Address Details
Address
Po Box 60447
City
Charlotte
State
North Carolina
Zip
28260-0447
Phone Number
704-384-5043
Fax Number
704-384-8895
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
-
Taxonomy
363A00000X
License No.
102472 (North Carolina)
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
102472 (North Carolina)
Definition
Definition to come...
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