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

Susan R Wallace

Individual provider Family Nurse Practitioner · NPI 1740537687

Susan R Wallace is a Nurse Practitioner in Hattiesburg, Mississippi. Qualified in 1995, 31 years ago. Practices with Gastrointestinal Associates PA, a 45-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
31
Licensed in
MS
In the registry since
2012
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

100 Methodist Blvd
Hattiesburg, MS 39402-1295
Phone: (601) 268-6738
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence R852101 (MS)

Record details

NPI number1740537687
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 9, 2012
Last updated in NPPESAugust 10, 2012

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice Gastrointestinal Associates Pa — 45 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Hattiesburg