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

Mr. Jared Lee Wallace, PA-C

Individual provider Physician Assistant · NPI 1063746667

Mr. Jared Lee Wallace, PA-C is a Physician Assistant in Kenai, Alaska. Qualified in 2009, 17 years ago. Practices with Odyssey Family Practice, a 5-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
17
In the registry since
2009
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 →

Practice location Address checks out

43783 Kenai Spur Hwy
Kenai, AK 99611
Phone: (907) 283-9116
Fax: (907) 283-9122
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1063746667
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 29, 2009
Last updated in NPPESMarch 7, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice Odyssey Family Practice — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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