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Active NPI 1255274411 Individual Practitioner Female Practitioner

Edna Fells Wallace , LPN

Licensed Practical Nurse • Fayette, MS

Professional Overview & Biography Verified Profile Summary

Edna Wallace, LPN is a registered healthcare professional specializing in Licensed Practical Nurse in Fayette, MS. Practice services are available at 1555 N. MAIN STREET under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1555 N. Main Street

Fayette, MS 39069

Telephone 6017868091
Fax 6017868023

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Fayette, MS

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 20.0 Yrs
Regional Practice Density
2 Specialists

Practicing in Fayette, MS (263 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-04-06
Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License MS P189022

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Kadeshia Hunt , PCMHT

Counselor - Mental Health

NPI 1073153656
Gloria Gray

Counselor - Mental Health

NPI 1558724880
Irving Grayson

Counselor - Mental Health

NPI 1568089274
Briana Proby

Counselor - Mental Health

NPI 1730964263
Imani Green

Counselor - Mental Health

NPI 1992515530

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active April 13, 2026

NPI status registered as active in NPPES database

📍
Updated Practice Location April 13, 2026

Registered at 1555 N. MAIN STREET, FAYETTE, MS 39069 (Tel: 6017868091)

📍
Updated Business Mailing Address April 13, 2026

Registered at PO BOX 194, LORMAN, MS 390960194 (Tel: 6018098901)

👤
Provider Name / Credentials Updated April 13, 2026

Recorded as EDNA WALLACE, LPN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 13, 2026

Licensed Practical Nurse (License #P189022 in MS)

🟢
Initial NPI Registration & Enumeration April 13, 2026

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1255274411
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 13, 2026
Last Update: April 13, 2026
Sole Proprietor: No

Mailing Address

Po Box 194

Lorman, MS 390960194

Phone: 6018098901

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.