IndividualActive
Donetta Wallace, P.A.-C
NPI 1417958828 · Physician Assistant · Paintsville, KY
Provider details
- NPI number
- 1417958828
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- P.A.-C
- Sex
- Female
- Sole proprietor
- No
- License
- PA544 (KY)
Practice location
336 N Mayo Trl
Paintsville, KY 41240-1804
Phone: (606) 789-8666
Fax: (606) 788-0253
Mailing address
Po Box 2379
Ashland, KY 41105-2379
Registry dates
- Enumerated
- 2005-08-09
- Last updated
- 2022-02-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.