Wanda Ikeda, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

R696196 Issued in MS

Practice address

499 Gloster Creek VLG Ste A2
Tupelo, MS 38801-4749

Phone

(662) 620-6800

Fax

(662) 377-2403

NPI assigned

Jun 28, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1013114677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3488",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033488",
            "telephone_number": "662-377-2949",
            "fax_number": "662-377-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE A2",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014749",
            "telephone_number": "662-620-6800",
            "fax_number": "662-377-2403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2892 S LaMar Blvd",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "MS",
            "postal_code": "386555347",
            "country_code": "US",
            "telephone_number": "662-234-7441",
            "fax_number": "662-620-6950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IKEDA",
        "first_name": "WANDA",
        "name_prefix": "Ms.",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R696196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Huwe, PHARMD
• Susan Patrice Hyatt, PH.D.
• Patricia Ross Hych, MA
• Atif Ibrahim
• Omer Mohamed Ali Ibrahim, BDS, DDS
• Illuminated Life Counseling LLC
• Imaging Center at Gloster Creek Village PLLC
• Abrahim Imam
• Laura Akugbe Imarhiagbe, M.D.
• Malinda Ingram, FNP

• Acute Care Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Acute Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.