Individual
KRISTEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2470 FLOWOOD DR, FLOWOOD, MS 39232-9019
(601) 664-1213
(601) 932-8869
Mailing address
2470 FLOWOOD DR, FLOWOOD, MS 39232-9019
(601) 664-1213
(601) 932-8869
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901914
MS
Other
Enumeration date
01/18/2017
Last updated
01/18/2017
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