Healthcare Provider Details

I. General information

NPI: 1275858599
Provider Name (Legal Business Name): CATHY WILBURN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JACKSON AVE W
OXFORD MS
38655-2154
US

IV. Provider business mailing address

PO BOX 187
HOULKA MS
38850-0187
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-6464
  • Fax: 662-234-6433
Mailing address:
  • Phone: 662-568-3316
  • Fax: 662-568-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850403
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: