NPIMap

Individual provider Active NPI

Tanyaneka Wilson, FNP-BC

  • Family Nurse Practitioner
  • Meridian, MS
National Provider Identifier
1104243831
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R862382 Issued in MS
Practice address
2701 Davis St
Meridian, MS 39301-5708
Phone
(601) 693-0118
Fax
(844) 778-8922
NPI assigned
Mar 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R862382 MS Primary

Addresses

Primary practice location

2701 Davis St
Meridian, MS 39301-5708

Mailing address

2701 Davis St
Meridian, MS 39301-5708
Phone (601) 693-0118

Other identifiers 1

IdentifierTypeStateIssuer
004671271MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140516001496 MS Practitioner - Nurse Practitioner 7719100890 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Greater Meridian Health Clinic, Inc.Group PAC ID 9032027834, 13 clinicians

Practice addresses (Care Compare)

2701 Davis St
Meridian, MS 39301-5708
Phone (601) 693-0118

Hospital & facility affiliations

  • Deaconess Homecare- Region I Home health agency, Laurel, MS, CCN 257085
  • Anderson Regional Medical Center Hospital, Meridian, MS, CCN 250104
  • Ochsner Rush Hospital Hospital, Meridian, MS, CCN 250069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R862382MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Meridian Health Clinic, Inc. Current Accepting new patients
Nurse Practitioner Associates of Meridian CurrentSince Dec 14, 2021 Accepting new patients
Behavioral Health Services of Meridian CurrentSince Apr 17, 2022 Accepting new patients
Greater Meridian Health Clinic, Inc. CurrentSince Jul 11, 2023 Accepting new patients
Greater Meridian Health Clinic, Inc. Past Accepting new patients

Locations

201 Birch St
De Kalb, MS 39328
Phone (601) 743-2642

2701 Davis St
Meridian, MS 39301
Phone (601) 693-0118

3701 8th St
#B
Meridian, MS 39307
Phone (601) 282-1933

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1104243831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 DAVIS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393015708",
            "telephone_number": "601-693-0118",
            "fax_number": "601-553-8175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 DAVIS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393015708",
            "telephone_number": "601-693-0118",
            "fax_number": "844-778-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TANYANEKA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-19",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R862382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004671271",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.