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

Mikayla Wallace

Individual provider Physician Assistant · NPI 1962162875

Mikayla Wallace is a Physician Assistant in Jersey City, New Jersey. Practices as a sole proprietor. Licensed in New Jersey.

Licensed in
NJ
In the registry since
2021
Specialties on file
2

Practice location Address checks out

355 Grand St
Jersey City, NJ 07302-4321
Phone: (201) 915-2000
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence 25MP00684600 (NJ)

Record details

NPI number1962162875
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedDecember 20, 2021
Last updated in NPPESJuly 30, 2024
Certification dateJuly 30, 2024
Mailing address113 Hofstra University Rm 231, Hempstead, NY 11549-1925

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