Individual provider · Type 1 NPI

Dedra Danyale Wallace

Surgical Assistant · Laurel, MS

NPI number 1477484632 Active

Practice location

1220 Jefferson St
Laurel, MS 39440-4355

Call (601) 426-4000 Map

Mailing address

3640 Old Bay Springs Rd
Laurel, MS 39440-1461

Specialties and licenses

TaxonomyCodeLicense
Surgical Assistant Primary 246ZC0007X100297090 (MS)

Surgical Assistant: A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in h…

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About NPI 1477484632

Dedra Danyale Wallace's National Provider Identifier is 1477484632, issued on May 27, 2026. The primary taxonomy on file is Surgical Assistant (246ZC0007X), and the practice location is in Laurel, MS. The record was last updated on May 27, 2026.