IndividualActive
Dedra Wallace
NPI 1477484632 · Surgical Assistant · Laurel, MS
Dedra Wallace is a Surgical Assistant provider in Laurel, MS (NPI 1477484632).
Provider details
- NPI number
- 1477484632
- Entity type
- Individual
- Primary specialty
- Surgical AssistantTechnologists, Technicians & Other Technical Service Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- 100297090 (MS)
Specialties & taxonomies
Technologists, Technicians & Other Technical Service Providers
Profile Score
Established profile(52/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1220 Jefferson St
Laurel, MS 39440-4355
Phone: (601) 426-4000
Street-level locationGet directions
Mailing address
3640 Old Bay Springs Rd
Laurel, MS 39440-1461
Registry dates
- Enumerated
- 2026-05-27
- Last updated
- 2026-05-27
- Certified
- 2026-05-27
Frequently asked questions
- What is Dedra Wallace's NPI number?
- Dedra Wallace's National Provider Identifier (NPI) is 1477484632, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Dedra Wallace's specialty?
- Dedra Wallace is listed in the NPPES registry with a primary specialty of Surgical Assistant (Technologists, Technicians & Other Technical Service Providers).
- Where is Dedra Wallace located?
- Dedra Wallace's practice location on file with NPPES is 1220 Jefferson St, Laurel, MS 39440-4355.
- What is Dedra Wallace's phone number?
- The practice phone number listed in the NPPES registry for Dedra Wallace is (601) 426-4000.
- Is Dedra Wallace's NPI active?
- Yes — Dedra Wallace's NPI (1477484632) is active in the NPPES registry as of the last update on 2026-05-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.