Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kristina Marie Wallace, PA-C

Individual provider Physician Assistant · NPI 1417326984

Kristina Marie Wallace, PA-C is a Physician Assistant in Grants Pass, Oregon. Qualified in 2015, 11 years ago. Practices with Peacehealth Medical Group, a 254-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
11
Licensed in
OR
In the registry since
2015
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

537 Union Ave Second Fl
Grants Pass, OR 97527-5543
Phone: (541) 479-6777
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA174747 (OR)

Record details

NPI number1417326984
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 15, 2015
Last updated in NPPESJune 8, 2020
Certification dateJune 8, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Peacehealth Medical Group — 254 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Grants Pass