Healthcare Provider Details

I. General information

NPI: 1174453765
Provider Name (Legal Business Name): PEDIATRIC PATHWAYS NURSING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WOODGATE DR
BRANDON MS
39042-2214
US

IV. Provider business mailing address

36 WOODGATE DR
BRANDON MS
39042-2214
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-5269
  • Fax:
Mailing address:
  • Phone: 601-218-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAVEEN WILSON
Title or Position: OWNER / MANAGER
Credential: RN
Phone: 601-218-5269