# JOHN WALLI NPC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295598043
- **Authorized official:** JOHN WALLI (NP-C)
- **Authorized official phone:** (228) 860-5164

## Contact information

- **Practice address:** 2781 C T SWITZER SR DR, BILOXI, MS 39531-4536
- **Practice address phone:** (228) 594-2900
- **Mailing address:** 16443 DELIA DR, BILOXI, MS 39532-9411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2024
- **Last updated:** 02/05/2024