Denisa Broome Wilson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

905068 Issued in MS

Practice address

907 US 49
Richland, MS 39218

Phone

(601) 374-5263

NPI assigned

Jan 21, 2022

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Central Mississippi Civic Improvement Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1134151442
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559

  Family

  Medicare reassignment NPD
• Central Mississippi Civic Improvement Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1215744396
  NPD
• Central Mississippi Civic Improvement Association, Inc.

  • Federally Qualified Health Center (FQHC)
  • Edwards, MS
  • NPI 1346684826
  NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1134871007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "UTICA",
            "state": "MS",
            "postal_code": "391750490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 US 49",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "39218",
            "telephone_number": "601-374-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DENISA",
        "middle_name": "BROOME",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "905068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Morgan Westcott
• Starece Westheimer
• Kimberly Elaine Wier, OTR/L
• Wiley Vision Care LLC
• Mark Eugene Wiley, O.D.
• Theresa Ann Woodard, PHD
• Brandy M Wrenn
• Amanda Yates, RPH
• William J Zaremba Jr., PTA

• Family Nurse Practitioner in Richland, MS
• Providers in Richland, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.