Individual
MRS. KARLA MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
314 MAIN ST STE B, MONTICELLO, MS 39654-3702
(601) 587-4304
Mailing address
314 MAIN ST STE B, MONTICELLO, MS 39654-3702
(601) 587-4304
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902985
MS
Other
Enumeration date
10/24/2018
Last updated
04/28/2019
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