Individual
CYNEICEYA ANNETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, AGPCNP-BC
Contact information
Practice address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(662) 459-7000
Mailing address
406 KEESLER ST, GREENWOOD, MS 38930-3216
(662) 299-9832
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
906657
MS
Other
Enumeration date
05/14/2024
Last updated
05/14/2024
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