Individual
PAMELA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
860 DESOTO EXT, CLARKSDALE, MS 38614
(662) 624-4316
(662) 621-1151
Mailing address
580 FRIARS POINT RD, CLARKSDALE, MS 38614-9734
(662) 624-4316
(662) 624-4354
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R757715
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125696
—
MS
Enumeration date
08/10/2005
Last updated
05/06/2009
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