Wanderful Porter, FNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

R748355 Issued in MS

Practice address

602 Brunson Dr
Tupelo, MS 38801-4947

Phone

(662) 680-3855

Fax

(662) 680-3372

NPI assigned

Dec 22, 2005

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

Other identifiers 1

Other names 1

• Wanda E Ford Former name

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13706/brand/1/csg/1/fhir/r4

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.

• Ms State Department of Health

  • Community/Behavioral Health Agency
  • Jackson, MS
  • NPI 1053489260
  Medicare reassignment NPD
• North Mississippi Medical Center Inc

  • Psychologist
  • Tupelo, MS
  • NPI 1972608347
  Medicare reassignment NPD
• Sanders Clinic for Women PA

  • Obstetrics & Gynecology Physician
  • Tupelo, MS
  • NPI 1962423046
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  MS

  Medicare reassignment NPD
• Mississippi State Department of Health

  • Clinical Medical Laboratory
  • Jackson, MS
  • NPI 1255479630
  NPD
• Ms State Dept of Health

  • Long Term Care Pharmacy
  • Jackson, MS
  • NPI 1376606582
  NPD
• North Mississippi Medcial Center, Inc.

  • Diagnostic Radiology Physician
  • Tupelo, MS
  • NPI 1902762487
  NPD
• North Mississippi Medical Center

  • Family Medicine Physician
  • Tupelo, MS
  • NPI 1063739290
  NPD
• Amory Surgery Clinic, PLLC

  • Surgery Physician
  • Amory, MS
  • NPI 1821441080
  NPD (past)

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1407833221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 BRUNSON DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014947",
            "telephone_number": "662-680-3855",
            "fax_number": "662-680-3372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 BRUNSON DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014947",
            "telephone_number": "662-680-3855",
            "fax_number": "662-680-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "WANDERFUL",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-22",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "R748355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00124068",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "FORD",
            "middle_name": "E",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Porchlight Marriage and Family Therapy
• Bruce Edward Porter, MD
• Elizabeth Porter
• John Ryan Porter
• Mark L. Porter, ATC
• Jon T Posey, MD
• Terrell James Potter, DO
• Bryan Pounders, PCCSS
• Cina Pourhashemi
• Joel Anthony Powell, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.