Individual
VITA J WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
250 BEAUVOIR RD STE 5, BILOXI, MS 39531-4026
(228) 388-2599
Mailing address
1452 TALLY HO CIR, GULFPORT, MS 39507-4229
(228) 896-7568
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R671908
MS
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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