Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kellie L Wallace-Wilding, MD

Individual provider Family Medicine Physician · NPI 1063518629

Kellie L Wallace-Wilding, MD is a Family Practice in Jackson, Tennessee. Qualified in 2005, 21 years ago. Practices with Jackson Clinic PA, a 176-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Tennessee.

Years since qualifying
21
Licensed in
TN
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2863 Highway 45 Byp
Jackson, TN 38305-3618
Phone: (731) 664-1375
Fax: (731) 664-1378
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 41583 (TN)

Record details

NPI number1063518629
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 14, 2006
Last updated in NPPESNovember 29, 2012

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Jackson Clinic Pa — 176 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations9 on file with Medicare

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