Healthcare Provider Details

I. General information

NPI: 1073334975
Provider Name (Legal Business Name): TERRIE S WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL BLVD COLLINS
COLLINS MS
39428
US

IV. Provider business mailing address

PO BOX 2499
COLLINS MS
39428-2499
US

V. Phone/Fax

Practice location:
  • Phone: 601-698-0328
  • Fax: 601-765-2808
Mailing address:
  • Phone: 601-765-6711
  • Fax: 601-698-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906643
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: