Individual
CALLISSA G WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1706 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2028
(601) 649-7805
Mailing address
1706 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2028
(601) 649-7805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
903129
MS
363LF0000X
Family Nurse Practitioner
015362
CT
363LF0000X
Family Nurse Practitioner
Primary
903129
MS
Other
Enumeration date
02/14/2019
Last updated
04/06/2026
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