Individual provider · Type 1 NPI

Crystal Nichole Wallace, NP-C

Nurse Practitioner · Hattiesburg, MS

NPI number 1629550496 Active

Practice location

7148 U S Highway 98 Ste 102
Hattiesburg, MS 39402-9133

Call (601) 475-8270 Map

Fax (769) 207-6209

Mailing address

3 Carrington Ct
Hattiesburg, MS 39402-8114

Other practice locations

106 Asbury Cir, Hattiesburg, MS 39402-1302 · (601) 268-8698
50 Parkway Ln Ste B, Petal, MS 39465-3035 · (601) 705-2897

Specialties and licenses

Taxonomy	Code	License
Nurse Practitioner Primary	363L00000X	902669 (MS)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

2 other providers at this address

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About NPI 1629550496

Crystal Nichole Wallace, NP-C's National Provider Identifier is 1629550496, issued on Aug 29, 2018. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Hattiesburg, MS. The record was last updated on Jun 2, 2025.