Individual
SHANNA NICOLA WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 MCCOMB AVE, PORT GIBSON, MS 39150-2915
(601) 747-5362
(601) 747-5362
Mailing address
103 MCCOMB AVE, PORT GIBSON, MS 39150-2915
(601) 747-5362
(601) 747-5362
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MS
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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