Shannon Laiche Wallace
NP | Nurse Practitioner
2100 Highway 61 N, Vicksburg
Mississippi, 39183-8211
601-883-5000
Shannon Laiche Wallace is a Vicksburg, Mississippi based nurse practitioner who is specialized as Nurse Practitioner. Active license number of Shannon Laiche Wallace is 908508 for Nurse Practitioner in Mississippi. Her current practice location is 2100 Highway 61 N, Vicksburg. Patients can reach her at 601-883-5000. Shannon Laiche Wallace is NP with specialization in Nurse Practitioner and her NPI number (Unique professional ID assigned by NPPES) is 1437084605.
Shannon Laiche 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:
Shannon Laiche 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: | Shannon Laiche Wallace |
| Specialization: | Nurse Practitioner (NP) |
| Gender: | Female |
| Credentials: | NP |
| Practice Address: | 2100 Highway 61 N, Vicksburg,
Mississippi, 39183-8211 |
| Phone: | 601-883-5000 |
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.
| NPI Number: | 1437084605 |
| NPI Enumeration Date: | 17 Jun, 2026 |
| NPI Last Update On: | 17 Jun, 2026 |
Medical Licenses:
NPs can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Shannon Laiche Wallace are as mentioned below.
| License Number | Specialization | State | Status | |
| 908508 | Nurse Practitioner | Mississippi | Primary | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Shannon Laiche Wallace
1071 West St,
Wesson, Mississippi |
| Zip: | 39191-7714 |
| Phone Number: | 601-883-4840 |
Patients can reach Shannon Laiche Wallace at
2100 Highway 61 N, Vicksburg, Mississippi or can
call to book an appointment on 601-883-5000.
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 July, 2026.