Individual
CRYSTAL NICHOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
7148 U S HIGHWAY 98 STE 102, HATTIESBURG, MS 39402-9133
(601) 475-8270
(769) 207-6209
Mailing address
3 CARRINGTON CT, HATTIESBURG, MS 39402-8114
(601) 810-8996
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902669
MS
Other
Enumeration date
08/29/2018
Last updated
06/02/2025
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