| Doctor Name: | MRS. KAYLA JUNE WALLACE |
| NPI Number: | 1891184388 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C, ARNP |
| License Number: | A119504 |
| Business Practice Address: | 1200 N 7th St Chariton, IA - 500491210 |
| Business Phone Number: | 6417748103 |
| Business Fax Number: | |
| Mailing Address: | 1200 N 7th St, CHARITON |
| State: | IA |
| Postal Code: | 500491210 |
| Phone Number: | 6417748103 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2015 |
| NPI Last Update Date: | 01/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A119504 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |