Healthcare Provider Details

I. General information

NPI: 1467367029
Provider Name (Legal Business Name): MANDY PATTERSON WEDGEWORTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 HIGHWAY 468
BRANDON MS
39042-9058
US

IV. Provider business mailing address

153 STONEHENGE RD
FLORENCE MS
39073-8580
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-0988
  • Fax:
Mailing address:
  • Phone: 601-824-0988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number908704
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: