Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Crystal Nichole Wallace, NP-C

Individual provider Nurse Practitioner · NPI 1629550496

Crystal Nichole Wallace, NP-C is a Nurse Practitioner in Hattiesburg, Mississippi. Qualified in 2018, 8 years ago. Practices with Hattiesburg Clinic PA, a 530-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
8
Licensed in
MS
In the registry since
2018
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

7148 U S Highway 98 Ste 102
Hattiesburg, MS 39402-9133
Phone: (601) 475-8270
Fax: (769) 207-6209
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

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

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 902669 (MS)

Record details

NPI number1629550496
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP-C
Sole proprietorNo
NPI enumeratedAugust 29, 2018
Last updated in NPPESJune 2, 2025
Certification dateJune 2, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Hattiesburg Clinic Pa — 530 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Hattiesburg