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General NPI Number Information
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NPI Number | 1437579091
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Entity Type | Individual
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Provider Name | STEPHANIE LAUREN WILSON FNP
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Gender | Female
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 1886 POPPS FERRY RD
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City | BILOXI
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State | MS
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Zip | 39532-2104
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Country | US
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Telephone | 228-338-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 1886 POPPS FERRY RD
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City | BILOXI
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State | MS
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Zip | 39532-2104
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Country | US
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Telephone | 904-521-9268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 885494
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 885494
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R885494
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License Number State | MS
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