Individual
KENYATTA NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2200 HIGHWAY 61 N, VICKSBURG, MS 39183-8246
(601) 883-3340
Mailing address
2200 HIGHWAY 61 N, VICKSBURG, MS 39183-8246
(601) 529-1445
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871546
MS
Other
Enumeration date
09/09/2011
Last updated
05/29/2023
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