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Contact Information

EDNA F WALLACE, LPN
1555 N. MAIN STREET
FAYETTE, MS39069
 Phone: 601-786-8091
 Fax: 601-786-8023
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Licensed Practical Nurse

164W00000X
Indicates primary specialty

NPI Profile & details for EDNA F WALLACE · (Female)

NPI Number 1255274411
Status Active
Credentials LPN (Licensed Practical Nurse)
Entity Individual
Enumeration date 04/13/2026
Last updated 04/13/2026 - About 2 months ago
Sole proprietor 1 No
Identifiers
  • MS License # P189022
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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