Wilson, Brandye Nicole

Wilson, Brandye Nicole is an individual health care provider with primary practice located at 125 Goodman Rd W Ste D , Southaven MS 38671-9481. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Wilson, Brandye Nicole can be contacted via phone (662) 932-3560.

Contact Information

Primary practice address
125 Goodman Rd W Ste D Southaven MS 38671-9481
Phone: (662) 932-3560
Fax: (662) 534-2330
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA362 Arkansas
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA00448 Mississippi

Profile Details

NPI number 1215189618
LBN Legal business name Wilson, Brandye Nicole
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2008
Last updated Sep 28th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215189618 NPPES
Mississippi Other 873993 MS MEDICARE
Mississippi MEDICAID 00133522 MS MEDICARE

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