Provider Demographics
NPI:1992045538
Name:WILBURN, CAROL MICHELLE (NNP-BC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MICHELLE
Last Name:WILBURN
Suffix:
Gender:
Credentials:NNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:OWEN
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:325 PROVISION PKWY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-7912
Mailing Address - Country:US
Mailing Address - Phone:601-668-7242
Mailing Address - Fax:
Practice Address - Street 1:5 RIVER BEND PL STE C
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7618
Practice Address - Country:US
Practice Address - Phone:601-957-7345
Practice Address - Fax:769-251-5429
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS860590363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care