Provider Demographics
NPI:1235403874
Name:WILSON, SARAH K (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OLD SPANISH TRAIL
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553
Mailing Address - Country:US
Mailing Address - Phone:228-205-7700
Mailing Address - Fax:228-205-7715
Practice Address - Street 1:210 OLD SPANISH TRAIL
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-205-7700
Practice Address - Fax:228-205-7715
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS30250I4396OtherMEDICARE
MS5799138OtherCIGNA
MS9740799OtherAETNA
MS09221069Medicaid
MS3431557OtherUHC