Jordan Jehree Wallace, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-1208 Issued in AR

Practice address

5620 W Markham St
Little Rock, AR 72205-3327

Phone

(501) 508-7163

Fax

(501) 203-9850

NPI assigned

Sep 22, 2023

Last updated

Sep 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

American Oncology Partners PAGroup PAC ID 0042569758, 377 clinicians

University of Arkansas for Medical SciencesGroup PAC ID 4082528955, 1,159 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center-Little Rock Hospital, Little Rock, AR, CCN 040114
• University of Arkansas Medical Sciences Hospital, Little Rock, AR, CCN 040016

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016
  Medicare reassignment Care Compare group
• American Oncology Partners PA

  • Hematology & Oncology Physician
  • Columbus, OH
  • NPI 1265929723

  AR

  Medicare reassignment Care Compare group
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• University of Arkansas for Medical Sciences

  • Child & Adolescent Psychiatry Physician
  • Little Rock, AR
  • NPI 1467528026
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Health

  dba Baptist Health Medical Center-Little Rock

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1043240682
  Care Compare affiliation
• University of Arkansas for Medical Sciences

  dba The University Hospital of Arkansas

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1477549756
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1063291789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749495",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749495",
            "telephone_number": "855-963-2100",
            "fax_number": "813-321-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053327",
            "telephone_number": "501-508-7163",
            "fax_number": "501-203-9850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 Centerview Dr",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722114349",
            "country_code": "US",
            "telephone_number": "501-507-6035",
            "fax_number": "833-985-3162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3 Medical Park Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Benton",
            "state": "AR",
            "postal_code": "720153700",
            "country_code": "US",
            "telephone_number": "501-507-6035",
            "fax_number": "501-776-9677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JORDAN",
        "middle_name": "JEHREE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-22",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PA-1208",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-1208",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Wallace, LPTN
• Chakiah Wallace, LAC
• Chrisopher Wallace
• Jamelia Wallace
• Jimmie Lou Wallace, CRNA
• Joshua Taylor Wallace, APRN
• Madeline G Wallace, RD
• Meagan Wallace
• Tabitha A Wallace, RDH
• Thomas Witherspoon Wallace, MD

• Medical Physician Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.