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

Individual provider Medical Physician Assistant · NPI 1619179132

Connie Sue Wallace, PA-C is a Medical Physician Assistant in Huntersville, North Carolina. Works from 2 locations. Licensed in North Carolina.

Licensed in
NC
In the registry since
2007
Specialties on file
2
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

10030 Gilead Rd Ste 201
Huntersville, NC 28078-7545
Phone: (704) 887-4530
Fax: (704) 887-4531
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 125 Queens Rd Ste 330, Charlotte, NC 28204-3215 — (704) 384-5043

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 102472 (NC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 102472 (NC)

Record details

NPI number1619179132
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 5, 2007
Last updated in NPPESAugust 23, 2022
Certification dateAugust 23, 2022

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