Provider Demographics
NPI:1336177021
Name:WILSON -SIMPSON, FELISA DENISE (CPNP, CFNP)
Entity Type:Individual
Prefix:MS
First Name:FELISA
Middle Name:DENISE
Last Name:WILSON -SIMPSON
Suffix:
Gender:F
Credentials:CPNP, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DIVISION OF GASTROENTEROLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5534
Mailing Address - Fax:601-984-4548
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5534
Practice Address - Fax:601-984-4548
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR784445363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120383Medicaid
MS251933Medicare Oscar/Certification
MS00120383Medicaid
MSC01051Medicare Oscar/Certification
MSQ67185Medicare UPIN
MSP01676215Medicare PIN
MS500002098Medicare PIN
MS302I504587Medicare PIN
MS251936Medicare Oscar/Certification