Healthcare Provider Details

I. General information

NPI: 1174455075
Provider Name (Legal Business Name): ANNA KATE WILBANKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 CURTIS DR
IUKA MS
38852-1001
US

IV. Provider business mailing address

366 COUNTY ROAD 512
CORINTH MS
38834-8141
US

V. Phone/Fax

Practice location:
  • Phone: 662-423-6014
  • Fax:
Mailing address:
  • Phone: 662-415-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908384
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: