Individual
DENISA BROOME WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
907 US 49, RICHLAND, MS 39218
(601) 374-5263
Mailing address
PO BOX 490, UTICA, MS 39175-0490
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
905068
MS
Other
Enumeration date
01/21/2022
Last updated
05/19/2022
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