Provider Demographics
NPI:1073334975
Name:WILSON, TERRIE S (FNP-C)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2499
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-2499
Mailing Address - Country:US
Mailing Address - Phone:601-765-6711
Mailing Address - Fax:601-698-0112
Practice Address - Street 1:301 HOSPITAL BLVD
Practice Address - Street 2:COLLINS
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428
Practice Address - Country:US
Practice Address - Phone:601-698-0328
Practice Address - Fax:601-765-2808
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner