Shannon Laiche Wallace, NP
NPI 1437084605ActiveIndividual· Nurse Practitioner· Vicksburg, MS
Nurse Practitioner (NP) with Jackson Hb Medical Services LLC, practicing in Vicksburg, Mississippi. Enrolled in Medicare as practitioner - nurse practitioner. Lists Merit Health River Region as a hospital affiliation.
Overview
| NPI | 1437084605 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | NP |
| Sole proprietor | Yes |
| NPI issued | Jun 17, 2026 |
| Last updated in NPPES | Jun 17, 2026 |
| Certified by provider | May 27, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 908508 | MS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (MS) |
|---|
Education and affiliations
| Graduation year | 2026 |
|---|---|
| Medicare specialty | Nurse Practitioner |
Medical group
- Jackson Hb Medical Services LLCVicksburg, MS · 52 clinicians
Hospital affiliation
- Merit Health River RegionVicksburg, MS
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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