Individual
MRS. EDNA FELLS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1555 N. MAIN STREET, FAYETTE, MS 39069
(601) 786-8091
(601) 786-8023
Mailing address
PO BOX 194, LORMAN, MS 39096-0194
(601) 809-8901
(601) 786-8023
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P189022
MS
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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