Irene Wilson, FNP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

902979 Issued in MS

Practice address

75 Physicians LN
Southaven, MS 38671-6102

Phone

(662) 393-7722

NPI assigned

Nov 2, 2018

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 names 1

• Irene Diaz 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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desoto Family Medical CenterGroup PAC ID 2567470412, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Desoto Family Medical Center

  • Family Medicine Physician
  • Southaven, MS
  • NPI 1528150398
  Medicare reassignment Care Compare group NPD
• Providence Health, PLLC

  • Nurse Practitioner
  • Southaven, MS
  • NPI 1134795628
  NPD Authorized official

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

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541116800000",
    "number": "1477021988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 CLARINGTON DR",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715638",
            "telephone_number": "901-486-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PHYSICIANS LN",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716102",
            "telephone_number": "662-393-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "IRENE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-02",
        "last_updated": "2018-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "902979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENE",
            "last_name": "DIAZ",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tajuana Lashe' Williams, M.ED, NCC, LPC
• Tracy Leigh Williamson, RDN, LD
• Robin Willis, PHARMD
• Antoinette Shane Wilson Banks, REGISTERED NURSE
• Brandye Nicole Wilson, P.A.
• Jonathan William Wilson, O.D.
• Leslie Diane Wilson, PT
• Savannah Wilson, MS
• Shirley Ann Wilson, PHD
• Amanda L Wiltshire, AGNP-C

• Primary Care Nurse Practitioner in Southaven, MS
• Providers in Southaven, 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 Nov 2, 2018; 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.