Healthcare Provider Details

I. General information

NPI: 1780299875
Provider Name (Legal Business Name): CATHERINE LEIGH WILSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH WILSON NP

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date: 12/13/2021
Reactivation Date: 03/21/2022

III. Provider practice location address

104 BURNEY DR
FLOWOOD MS
39232-6621
US

IV. Provider business mailing address

104 BURNEY DR
FLOWOOD MS
39232-6621
US

V. Phone/Fax

Practice location:
  • Phone: 601-987-8200
  • Fax: 601-987-8211
Mailing address:
  • Phone: 601-987-8200
  • Fax: 601-987-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902723
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: