Individual
MR. EMERSON AKALEE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFNP
Contact information
Practice address
1154 CROSS CREEK DR, SALTILLO, MS 38866-5777
(662) 840-8010
(662) 840-2656
Mailing address
118 CR1810, SALTILLO, MS 38866
(662) 844-6596
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R759298
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0117978
—
MS
Enumeration date
09/01/2006
Last updated
07/08/2007
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