Crystal Nichole Wallace
NP-C | Nurse Practitioner | 7+ years Exp
7148 U S Highway 98 Ste 102, Hattiesburg
Mississippi, 39402-9133
601-475-8270
Crystal Nichole Wallace is a Hattiesburg, Mississippi based nurse practitioner with 7 years of experience in . She completed her graduation in 2018. She accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Crystal Nichole Wallace is 902669 in Mississippi. Her current practice location is 7148 U S Highway 98 Ste 102, Hattiesburg. Patients can reach her at 601-475-8270 or can fax her at 769-207-6209. Crystal Nichole Wallace is NP-C and her NPI number (Unique professional ID assigned by NPPES) is 1629550496.
Crystal Nichole Wallace has completed additional training beyond basic nursing education and provides primary health care services in accordance with state nurse practice laws or statutes. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans.
Complete Profile:
Crystal Nichole Wallace speciality, credentials, practice address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointment.
| Name: | Crystal Nichole Wallace |
| Specialization: | Nurse Practitioner (NP) |
| Gender: | Female |
| Credentials: | NP-C |
| Experience: | 7+ years |
| Medical School Attended: | Other |
| Graduation Year: | 2018 |
| Accepts Medicare Assignment: | Yes |
| Practice Address: | 7148 U S Highway 98 Ste 102, Hattiesburg,
Mississippi, 39402-9133 |
| Phone: | 601-475-8270 |
| Fax: | 769-207-6209 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| PAC ID: | 1759625460 |
| Enrollment ID: | I20181206003458 |
| NPI Number: | 1629550496 |
| NPI Enumeration Date: | 29 Aug, 2018 |
| NPI Last Update On: | 02 Jun, 2025 |
Medical Licenses:
NPs can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Crystal Nichole Wallace are as mentioned below.
| License Number | Specialization | State | Status | |
| 902669 | | Mississippi | Primary | |
Group Practice:
Group practices are practice of medicine by a group of NPs who share their premises and other resources. Following list states all the group name
with which Crystal Nichole Wallace is associated with along with the number of members in that group.
| Organization Name (Group PAC ID) | Members |
| Fast Pace Mississippi Pllc (3678832029) | 121 |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Crystal Nichole Wallace
3 Carrington Ct,
Hattiesburg, Mississippi |
| Zip: | 39402-8114 |
| Phone Number: | 601-810-8996 |
Patients can reach Crystal Nichole Wallace at
7148 U S Highway 98 Ste 102, Hattiesburg, Mississippi or can
call to book an appointment on 601-475-8270.
Comments/ Reviews:
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.