Healthcare Provider Details

I. General information

NPI: 1427306091
Provider Name (Legal Business Name): ALISON PAIGE WILDMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISON PAIGE PRESLEY

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 MARIA LANE
IUKA MS
38852-1135
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-423-3332
  • Fax: 662-423-3331
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-286-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR870662
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: