Wallace Stevens, Alicia Lachelle
Wallace Stevens, Alicia Lachelle is an individual health care provider with primary practice located at 1407 S Main St , Poplarville MS 39470-3369. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Wallace Stevens, Alicia Lachelle can be contacted via phone (601) 795-0659.Contact Information
Primary practice address
1407 S Main St
Poplarville MS 39470-3369
Phone: (601) 795-0659
Fax: (601) 795-8639
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | PGY.2.TUL-MEDPD | Louisiana |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 21723 | Mississippi |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | PGY.2.TUL-MEDPD | Louisiana |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 21723 | Mississippi |
Profile Details
| NPI number | 1699959882 |
|---|---|
| LBN Legal business name | Wallace Stevens, Alicia Lachelle |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 24th, 2007 |
| Last updated | Jul 20th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699959882 | NPPES |
| Mississippi | MEDICAID | 03205377 |
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