Callissa G Wilkerson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903129 Issued in MS

Practice address

1706 W 12TH St
Laurel, MS 39440-2559

Phone

(601) 369-2028

Fax

(601) 649-7805

NPI assigned

Feb 14, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Callissa Ladner Former name

Medicare fee-for-service enrollment

Enrolled in MS, CT, ID, TX, OH, NE6 enrollments

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 6

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.91 of 100Reported as group

Quality

73.71

Promoting interoperability

97

Improvement activities

40

Cost

64.52

Merit-based Incentive Payment System (MIPS)

Final score

20.71 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

69.04

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cladner18493@direct-prd.molinahealthcare.com

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.

• Molina Care Connections, LLC.

  • Nurse Practitioner
  • Long Beach, CA
  • NPI 1407243223

  CT, ID, MS, NE, OH, TX

  Medicare reassignment NPD
• Pain Consultants of South Mississippi PA

  • Pain Medicine (Anesthesiology) Physician
  • Hattiesburg, MS
  • NPI 1619920584

  MS

  Medicare reassignment
• Lakeland Radiologists P a

  • Diagnostic Radiology Physician
  • Jackson, MS
  • NPI 1861428351
  NPD (past)

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1144786229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 W 12TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402559",
            "telephone_number": "601-369-2028",
            "fax_number": "601-649-7805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 W 12TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402559",
            "telephone_number": "601-369-2028",
            "fax_number": "601-649-7805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 N 15th Ave",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "394403839",
            "country_code": "US",
            "telephone_number": "601-651-6362",
            "fax_number": "866-517-9628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "CALLISSA",
        "middle_name": "G",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-14",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903129",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1217447",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "903129",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "015362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALLISSA",
            "last_name": "LADNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amanda Sumer White, P-LPC
• Emily White, PHARMD
• Holly Marie White, APRN
• Valarie White
• Thomas Whitton, M.D.
• Williams Family Dentistry
• Amanda Williams, RN
• Emma Williams
• Niquia L Williams, LPN
• Nathan A Williamson, MD

• All providers in Laurel, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.