Individual
MS. LISA WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5000
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
117135-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
R815668
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430067914
RAILROAD MEDICARE
—
01
—
640942692
BLUE CROSS OF MS
—
05
—
LW00114294
—
MS
Enumeration date
02/28/2007
Last updated
04/02/2026
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