Pamela Wilson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R757715 Issued in MS

Practice address

860 Desoto Ext
Clarksdale, MS 38614

Phone

(662) 624-4316

Fax

(662) 621-1151

NPI assigned

Aug 10, 2005

Last updated

May 6, 2009By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Clarksdale Hma Physican Management, LLC

  dba Campbell Family Clinic

  • Rural Health Clinic/Center
  • Clarksdale, MS
  • NPI 1063654721
  NPD (past)
• Clarksdale Hma Physician Management LLC

  • Internal Medicine Physician
  • Clarksdale, MS
  • NPI 1740297688
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241568000000",
    "number": "1447251632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 FRIARS POINT RD",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386149734",
            "telephone_number": "662-624-4316",
            "fax_number": "662-624-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 DESOTO EXT",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-624-4316",
            "fax_number": "662-621-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "PAMELA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2009-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R757715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125696",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary A Williams, DNP, FNP-BC, PMHNP-C
• Shenetta Latrice Williams, FNP
• Teri Williams, FNP
• Amy Willis, MS
• Shalonda Elane Willis
• Tralezza Meshay Wilson
• William F Wilson Jr., DMD
• Carolyn D Womack, LCSW
• Woman's Clinic, a Professional Association
• Womans Clinic, a Professional Association

• Family Nurse Practitioner in Clarksdale, MS
• Providers in Clarksdale, 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 6, 2009; 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.