Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum

Mr. Jared Lee Wallace, PA-C

Physician Assistant in Kenai, AK · enumerated 2009 · practices at R Lynn Carlson MD PC Medicenter.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1063746667

Verified

See something wrong? Report a correction

Registry record

Entity type Individual (Type 1)

Name Mr. Jared Lee Wallace

Credential PA-C

Sex Male

Practice address 43783 Kenai Spur Hwy, Kenai, AK, 99611

Phone (907) 283-9116

Fax (907) 283-9122

Enumeration date Sep 29, 2009

Last updated in NPPES Mar 7, 2023

Taxonomy & licenses

363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Primary

Other identifiers

Identifier	Type	State	Issuer
1020379	Medicaid	AK	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Is NPI 1063746667 active?

Yes, as of the latest NPPES snapshot, NPI 1063746667 is active (record last updated 2023-03-07).

How do I verify Jared Wallace's NPI record?

Cross-check NPI 1063746667 against the official CMS registry at npiregistry.cms.hhs.gov. This page mirrors the same public NPPES data with a monthly snapshot.

Other providers at this practice address

Browse all →

R Lynn Carlson MD PC Medicenter Medical Physician Assistant · Nikiski, AK NPI 1215385794

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2023-03-07.