Individual
MRS. SHERITA DANIELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3514 HIGHWAY 39 N STE A&B, MERIDIAN, MS 39301-1305
(601) 512-1310
(833) 984-3427
Mailing address
3514 HIGHWAY 39 N STE A&B, MERIDIAN, MS 39301-1305
(601) 512-1310
(833) 984-3427
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
3-002311
AL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
37389
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902938
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00786527
—
MS
Enumeration date
01/22/2019
Last updated
07/29/2025
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