Organization
PROVIDENCE HEALTH, PLLC
Active
Other names
Providence Health
Organization subpart
No
Provider details
NPI number
Authorized official
IRENE WILSON FNP (FNP-C)
(901) 486-0439
Entity
Organization
Contact information
Practice address
7075 GOLDEN OAKS LOOP W STE 10, SOUTHAVEN, MS 38671-9012
(901) 486-0439
Mailing address
481 CLARINGTON DR, SOUTHAVEN, MS 38671-5638
(901) 486-0439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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