Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Colleen Elizabeth Wallace, PA-C

Individual provider Physician Assistant · NPI 1568187904

Colleen Elizabeth Wallace, PA-C is a Physician Assistant in Longmont, Colorado. Qualified in 2022, 4 years ago. Practices with Spine West a Professional LLC, a 9-clinician group and accepts Medicare assignment. Licensed in Colorado.

Years since qualifying
4
Licensed in
CO
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

600 S Airport Rd Bldg D
Longmont, CO 80503-6476
Phone: (303) 494-2705
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA.0007479 (CO)

Record details

NPI number1568187904
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 7, 2022
Last updated in NPPESSeptember 27, 2023
Certification dateSeptember 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Spine West A Professional Llc — 9 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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