Individual provider Active NPI

Abigail Joiner Wiltshire, MD

  • Pediatrics Physician
  • Kosciusko, MS
National Provider Identifier
1982282414
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
33285 Issued in MS
Practice address
332 Highway 12 W
Kosciusko, MS 39090-3209
Phone
(662) 289-1800
Fax
(662) 289-2486
NPI assigned
Mar 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33285 MS Primary

Addresses

Primary practice location

332 Highway 12 W
Kosciusko, MS 39090-3209

Mailing address

PO Box 23996
Jackson, MS 39225-3996
Phone (601) 206-6100

Other practice location 1

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-3535

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240626001825 MS Practitioner - Pediatric Medicine 7618411190 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33285MSMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group of Mississippi LLC CurrentSince Jul 15, 2024 Accepting new patients
Premier Medical Group of Mississippi LLC PastSince May 12, 2024 Accepting new patients

Locations

332 Highway 12 W
Kosciusko, MS 39090
Phone (601) 206-6100

530 Veterans Memorial Dr
Kosciusko, MS 39090
Phone (662) 289-9155

Interoperability endpoints

  • Direct secure messaging: abigail.wiltshire.1@27768.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1982282414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23996",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253996",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 HIGHWAY 12 W",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903209",
            "telephone_number": "662-289-1800",
            "fax_number": "662-289-2486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-815-3535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILTSHIRE",
        "first_name": "ABIGAIL",
        "middle_name": "JOINER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "33285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

Verify at the official NPI Registry.