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DEDRA DANYALE WALLACE
NPI 1477484632
Specialist/Technologist, Other - Surgical Assistant in Laurel, MS

Active since May 27, 2026
1220 JEFFERSON ST, LAUREL, MS 39440(601) 426-4000 Get Directions Write a Review

NPPES record last updated: May 27, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dedra Danyale Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEDRA DANYALE WALLACE (NPI 1477484632) is an individual surgical assistant in Laurel, Mississippi, licensed in Mississippi (100297090) and active in the NPI registry since May 2026.

NPPES Registry Identity

NPI1477484632
Entity TypeIndividualFemale
Primary Taxonomy246ZC0007X
Provider Legal NameDEDRA DANYALE WALLACE
Location Address1220 JEFFERSON STLaurel, MS 39440-4355
Mailing Address3640 Old Bay Springs RdLaurel, MS 39440-1461
Phone(601) 426-4000
Sole ProprietorYes
Enumeration DateMay 27, 2026
NPPES CertifiedMay 27, 2026
✔ NPI 1477484632 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialist/Technologist, Other · Surgical AssistantTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code246ZC0007X
License✔ Licensed in MS · 100297090
Definition
A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training.
1220 JEFFERSON ST, Laurel, MS 39440
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW MARTIN
Radiology (Diagnostic Radiology)
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 428-0100
MS. KAREN A LININGER FNP
Nurse Practitioner (Acute Care)
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4000
MRS. MELINDA DANETTE CHANCELLOR PT
Physical Therapist
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4119
MR. TOM A HALL
Physical Therapist
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 399-0534
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Clinic/Center
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4739
DR. CHARLES AARON HOLLINGSHEAD MD
Family Medicine
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4739
MR. GEORGE G COLLINS JR. P.T.
Physical Therapist
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4119
DR. JONATHAN J POLHEMUS MD
Family Medicine
1220 JEFFERSON ST
LAUREL, MS 39440
Jones County (601) 426-4507

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dedra Wallace's NPI number?

The NPI number for Dedra Wallace is 1477484632. It was assigned to this individual provider in the NPPES registry on May 27, 2026.

Where is Dedra Wallace located?

Dedra Wallace practices at 1220 Jefferson St, Laurel, MS 39440. The listed phone number is (601) 426-4000.

What is Dedra Wallace's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, Other, specializing in Surgical Assistant, with taxonomy code 246ZC0007X.

When was this NPI record last updated?

The NPPES record for Dedra Wallace was last updated on May 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.