Active NPI
Jerlunda Lynn Wilson, LCSW
- Clinical Social Worker
- Rosedale, MS
National Provider Identifier
1851755714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C8129
- Practice address
- 511 Clark Street
Rosedale, MS 39157 - Phone
- (662) 453-6211
- NPI assigned
- Apr 7, 2016
- Last updated
- Mar 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C8129 | MS | Primary |
Addresses
Primary practice location
511 Clark Street
Rosedale, MS 39157
Mailing address
511 Clark Street
Rosedale, MS 38769
Phone (769) 218-9821
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C8129 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678320000000",
"number": "1851755714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 CLARK STREET",
"city": "ROSEDALE",
"state": "MS",
"postal_code": "38769",
"telephone_number": "769-218-9821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 CLARK STREET",
"city": "ROSEDALE",
"state": "MS",
"postal_code": "39157",
"telephone_number": "662-453-6211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JERLUNDA",
"middle_name": "LYNN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-07",
"last_updated": "2023-03-09",
"certification_date": "2023-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "C8129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rosedale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.