Nelson Wilson, IV

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

C36423 Issued in MS

Legal business name

NELSON WILSON, IV

Doing business as

Extended Care Prosthetics of Mississippi

Practice address

801 E Northside Dr
Suite D
Clinton, MS 39056-3663

Phone

(601) 924-2888

Fax

(601) 924-2885

NPI assigned

Apr 27, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Nelson Wilson IV, C.P.NPI 1528228863

Title

Owner

Phone

(601) 951-7012

Specialties & licenses 1

Addresses

Other names 1

• Extended Care Prosthetics of Mississippi Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nelson Wilson IV, CP

  • Prosthetics Case Management
  • Clinton, MS
  • NPI 1528228863
  NPD (past) Authorized official

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1912141516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E NORTHSIDE DR",
            "address_2": "SUITE D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563663",
            "telephone_number": "601-924-2888",
            "fax_number": "601-924-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E NORTHSIDE DR",
            "address_2": "SUITE D",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563663",
            "telephone_number": "601-924-2888",
            "fax_number": "601-924-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELSON WILSON, IV",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-05-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-951-7012",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "C.P."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MS",
            "license": "C36423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Extended Care Prosthetics of Mississippi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valrie Morris
• Timothy Morrow IV
• Bridget Mraz, PTA
• Ms Mental Health
• Calin Mullins, FNP-C
• Stacie Thornton Nelson, PHARM.D.
• Newell Physical Therapy LLC
• Sarah Newell, PT
• Nexion Health at Clinton, Inc.
• Imogen Kieran Nicholas

• Prosthetic/Orthotic Supplier in Clinton, MS
• Providers in Clinton, MS by specialty
• Prosthetic/Orthotic Supplier in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.