Individual
KALA WHITE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
724 LEIGH DR, COLUMBUS, MS 39705-3098
(662) 328-3375
(662) 328-3395
Mailing address
724 LEIGH DR, COLUMBUS, MS 39705-3098
(662) 328-3375
(662) 328-3395
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R865872
MS
363LF0000X
Family Nurse Practitioner
Primary
R865872
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R865872
RN NP LICENSE NUMBER
MS
Enumeration date
02/27/2007
Last updated
05/24/2021
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