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NPI Code Detail

MEDICARE: JAQUELYN MICHELLE WILSON PA-C

MEDICARE: JAQUELYN MICHELLE WILSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMS

General Provider Information

NPI Number : 1982535498
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAQUELYN MICHELLE WILSON PA-C
Provider Business Mailing Address
First Line : 1075 CENTRE POINTE DR
Second Line :
City : BRANDON
State : MS
Zip : 39042-9698
Country : US
Telephone Number : 601-832-9702
Fax Number :
Provider Business Practice Location Address
First Line : 104 BURNEY DR
Second Line :
City : FLOWOOD
State : MS
Zip : 39232-6621
Country : US
Telephone Number : 601-803-7933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ JAQUELYN MICHELLE WILSON PA-C” Practice Location

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