MRS. JORDAN JEHREE WALLACE PA-C
NPI 1063291789
Physician Assistant - Medical in Little Rock, AR
About Mrs. Jordan Jehree Wallace Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. JORDAN JEHREE WALLACE PA-C (NPI 1063291789) is an individual medical provider in Little Rock, Arkansas, licensed in Arkansas (PA-1208) and active in the NPI registry since September 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).
NPPES Registry Identity
Specialties & Licenses 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mrs. Jordan Jehree Wallace Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LITTLE ROCK, AR 72205
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jordan Wallace's NPI number?
The NPI number for Jordan Wallace is 1063291789. It was assigned to this individual provider in the NPPES registry on September 22, 2023.
Where is Jordan Wallace located?
Jordan Wallace practices at 5620 W Markham St, Little Rock, AR 72205. The listed phone number is (501) 508-7163.
What is Jordan Wallace's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Jordan Wallace enrolled in Medicare?
Yes. Jordan Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Jordan Wallace accept?
Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and Ambetter from Superior HealthPlan and 5 other insurers list Jordan Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Jordan Wallace was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mrs. Jordan Jehree Wallace, PA-C · NPI 1063291789
Medical physician in Little Rock, Arkansas. Individual provider, active in the CMS NPPES registry since September 22, 2023.
## Identity
- **NPI:** 1063291789 (Entity type: Individual)
- **Enumerated:** September 22, 2023
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **State license:** PA-1208 (Arkansas)
- **Sole proprietor:** No
## Practice location
- **Address:** 5620 W MARKHAM ST, Little Rock, AR 72205-3327
- **Phone:** (501) 508-7163 · **Fax:** (501) 203-9850
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2023
## Record status
- **NPPES last updated:** September 15, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1063291789) · Data from the CMS NPPES public registry.