Dedra Danyale Wallace
Surgical Assistant · Laurel, MS
Practice location
1220 Jefferson StLaurel, MS 39440-4355
- Phone
- (601) 426-4000
NPI record
- NPI
- 1477484632
- Entity type
- Individual (Type 1)
- Enumeration date
- May 27, 2026
- Last updated
- May 27, 2026
- Certified
- May 27, 2026
- Sole proprietor
- Yes
Specialties & taxonomy codes
| Taxonomy | Code | License | State |
|---|---|---|---|
| Surgical Assistant Primary | 246ZC0007X |
100297090 | MS |
Mailing address
3640 Old Bay Springs RdLaurel, MS 39440-1461
About Dedra Wallace
Dedra Danyale Wallace is a healthcare provider registered in the NPI registry with the primary taxonomy Surgical Assistant (code 246ZC0007X). The practice location is 1220 Jefferson St, Laurel, MS 39440-4355. The NPI number 1477484632 was assigned on May 27, 2026 and the record was last updated on May 27, 2026.
Dedra Wallace lists a license in the registry: #100297090 (MS) for Surgical Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.
Frequently asked questions
What is the NPI number of Dedra Danyale Wallace?
The NPI number is 1477484632.
What is the phone number of Dedra Wallace?
The phone number listed for the practice location is (601) 426-4000.
Where is Dedra Wallace located?
1220 Jefferson St, Laurel, MS 39440-4355.
What is the taxonomy code for Dedra Wallace?
The primary taxonomy code is 246ZC0007X – Surgical Assistant.
Is this information correct?
All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.
Other Surgical Assistant providers in Laurel
- Jansci Smith1220 Jefferson St