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

Individual provider Athletic Trainer · NPI 1528516580

Mr. Khalil Rashaun Wallace is an Athletic Trainer in Fairchild AFB, Washington. Practices as a sole proprietor. Registered with an NPI since 2016.

In the registry since
2016
Specialties on file
2
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Practice location Address checks out

7275 Nebraska Ave
Fairchild AFB, WA 99011-3001
Phone: (786) 512-1492
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Athletic Trainer Taxonomy 2255A2300X

Record details

NPI number1528516580
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 19, 2016
Last updated in NPPESSeptember 19, 2016