Provider Demographics
NPI:1497280770
Name:WILDER, JESSICA (WHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CATTAIL LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3863
Mailing Address - Country:US
Mailing Address - Phone:601-624-5968
Mailing Address - Fax:
Practice Address - Street 1:128 CATTAIL LN
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3863
Practice Address - Country:US
Practice Address - Phone:601-624-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901811363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health