Crystal Nichole Wallace, NP-C in Petal, MS - Medicare Nurse Practitioner

Crystal Nichole Wallace, NP-C is a medicare enrolled "Nurse Practitioner" in Petal, Mississippi. She graduated from nursing school in 2018 and has 6 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Fast Pace Mississippi Pllc, Hattiesburg Clinic, Pa and her current practice location is 50 Parkway Ln Ste B, Petal, Mississippi. You can reach out to her office (for appointments etc.) via phone at (601) 705-2897.

Crystal Nichole Wallace is licensed to practice in Mississippi (license number 902669) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1629550496.

Contact Information

	Crystal Nichole Wallace, NP-C
	50 Parkway Ln Ste B, Petal, MS 39465-3035
	(601) 705-2897
	Not Available

Map and Direction

Provider's Profile

Full Name	Crystal Nichole Wallace
Gender	Female
Speciality	Nurse Practitioner
Experience	6 Years
Location	50 Parkway Ln Ste B, Petal, Mississippi
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Crystal Nichole Wallace graduated from nursing school in 2018

NPI Data:

NPI Number: 1629550496
Provider Enumeration Date: 08/29/2018
Last Update Date: 04/16/2024

Medicare PECOS Information:

PECOS PAC ID: 1759625460
Enrollment ID: I20181206003458

Medical Identifiers

Medical identifiers for Crystal Nichole Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1629550496	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	902669 (Mississippi)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Fast Pace Mississippi Pllc	3678832029	142
Hattiesburg Clinic, Pa	5193706794	488

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Crystal Nichole Wallace allows following entities to bill medicare on her behalf.

Entity Name	Hattiesburg Clinic Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1740213446 PECOS PAC ID: 5193706794 Enrollment ID: O20040528000685

Entity Name	Fast Pace Mississippi Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1447769559 PECOS PAC ID: 3678832029 Enrollment ID: O20180111000291

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Crystal Nichole Wallace is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Crystal Nichole Wallace, NP-C 3 Carrington Ct, Hattiesburg, MS 39402-8114 Ph: (601) 810-8996	Crystal Nichole Wallace, NP-C 50 Parkway Ln Ste B, Petal, MS 39465-3035 Ph: (601) 705-2897

Reviews and Comments

Nurse Practitioner Nurses in Petal, MS

Mrs. Hang My-thi Nguyen, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 100 Eastbrook Dr Ste 30, Petal, MS 39465 Phone: 601-336-5393
Mallory Stockstill, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1146 Evelyn Gandy Pkwy, Petal, MS 39465 Phone: 601-584-4309 Fax: 601-584-4890
David Lee Snodgrass, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1146 Evelyn Gandy Pkwy, Petal, MS 39465 Phone: 601-584-4309 Fax: 601-584-4890
Raven Miller, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 201 S Main St, Petal, MS 39465 Phone: 602-336-5626
Dayna Hamm Pridgen, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 50 Parkway Ln Ste B, Petal, MS 39465 Phone: 601-705-2897 Fax: 601-579-5240
Hope V Pittman, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1146 Evelyn Gandy Pkwy, Petal, MS 39465 Phone: 601-584-4309

Crystal Nichole Wallace, NP-C - Medicare Nurse Practitioner in Petal, MS