Provider Demographics
NPI:1609598242
Name:PEEPLES, SELENA WILKERSON (NP)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:WILKERSON
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:NP
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 5368
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-5368
Mailing Address - Country:US
Mailing Address - Phone:662-335-0183
Mailing Address - Fax:662-335-7184
Practice Address - Street 1:1513 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3249
Practice Address - Country:US
Practice Address - Phone:662-335-0183
Practice Address - Fax:662-335-7184
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily