Healthcare Provider Details

I. General information

NPI: 1609557396
Provider Name (Legal Business Name): WENDY WINSTON-BRISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LAKELAND DR STE B
JACKSON MS
39216-5029
US

IV. Provider business mailing address

111 APPLE BLOSSOM DR
BRANDON MS
39047-7443
US

V. Phone/Fax

Practice location:
  • Phone: 601-260-0385
  • Fax:
Mailing address:
  • Phone: 601-260-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906121
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906121
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: