MS. WANDA IKEDA (NPI# 1013114677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013114677 |
| Entity Type | Individual |
| Full Name | MS. WANDA IKEDA |
| Credential | ACNP |
| Practice Address |
499 Gloster Creek Vlg Ste A2 Tupelo MS 38801-4749 |
| Mailing Address |
Po Box 3488 Tupelo MS 38803-3488 |
| Practice Telephone | 6626206800 |
| Practice Fax Number | 6623772403 |
| Mailing Telephone | 6623772949 |
| Mailing Fax Number | 6623772403 |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
R696196 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2892 S Lamar Blvd, Oxford, MS 386555347 | 6622347441 | 6626206950 |
| Street Address |
499 GLOSTER CREEK VLG STE A2 |
| City | TUPELO |
| State | MS |
| Zip Code | 38801-4749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619919511 | Karl J. Crossen | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Cardiology Associates of North Ms, Tupelo, MS 38801-4749 | 2006-06-12 |
| 1538769161 | William Todd Sandroni | Pharmacist | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2020-11-01 |
| 1073157715 | Brandon Heath Petty | Nurse Practitioner | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2019-11-06 |
| 1023305687 | Michael Ted Boler Jr. | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2011-07-05 |
| 1366739054 | Richard Dane Ballard | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801 | 2011-07-01 |
| 1760797781 | Karthik Venkatesh Prasad | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2010-08-13 |
| 1619174299 | Gwendolyn H Hill | Nurse Practitioner | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2007-06-28 |
| 1265640148 | Amit Gupta | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Cardiology Associates of North Mississippi, Tupelo, MS 38801-4749 | 2007-05-21 |
| 1225190382 | Christopher M. Bell | Nurse Practitioner | 499 Gloster Creek Vlg Ste A2, Cardiology Associates of North Ms, Pa, Tupelo, MS 38801-4749 | 2006-12-15 |
| 1902971492 | Cardiology Associates of North Ms Pa | Internal Medicine | 499 Gloster Creek Vlg Ste A2, Tupelo, MS 38801-4749 | 2006-11-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1003443458 | Nicole Sherice Taylor | Nurse Practitioner | 845 South Gloster Street, Tupelo, MS 38801 | 2020-03-25 |
| 1821556838 | Wilco Healthcare of North Mississippi, Pllc | Point of Service | 1514 Co Rd 41, Tupelo, MS 38801 | 2019-03-08 |
| 1821565235 | Stephanie K Cagle | Nurse Practitioner | 218 S Thomas St Ste 120-121, Tupelo, MS 38801 | 2018-10-24 |
| 1073092326 | Lauren Parrish | Nurse Practitioner | 1573 Medical Park Circle, Tupelo, MS 38801 | 2018-08-08 |
| 1467948687 | North Mississippi Medcial Center, Inc. | Nurse Practitioner | 990 S Madison St Ste 2, Tupelo, MS 38801 | 2018-07-11 |
| 1043700933 | Hooks Diabetes & Medicine Clinic | Non-Pharmacy Dispensing Site | 2610 Traceland Drive, Ste A, Tupelo, MS 38801 | 2018-05-16 |
| 1073035903 | Annette C Riddle | Counselor | 1004 Eisenhower Drive, Tupelo, MS 38801 | 2017-07-12 |
| 1548709678 | Jaime Summers | Nurse Practitioner | 2780 West Jackson St, Tupelo, MS 38801 | 2017-02-22 |
| 1073975611 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 1168 Cross Creek Drive, Tupelo, MS 38801 | 2016-03-23 |
| Find all providers in zip 38801 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821583196 | Amanda Houston Trent | Nurse Practitioner | 4381 S Eason Blvd Ste 203, Tupelo, MS 38801-6557 | 2018-06-28 |
| 1922599752 | Megan Williams | Nurse Practitioner | 830 S Gloster St, Tupelo, MS 38801-4934 | 2018-05-29 |
| 1376065540 | Tony Mooney | Nurse Practitioner | 4381 S Eason Blvd Ste 302, Tupelo, MS 38801-6584 | 2017-07-10 |
| 1669922670 | Robin Jackson | Nurse Practitioner | 830 S Gloster St, 4th Floor East Tower, Tupelo, MS 38801-4934 | 2016-10-13 |
| 1073068003 | Ginger Mcmillan-buchanan | Nurse Practitioner | 830 S Gloster St, 3rd Floor East Tower, Tupelo, MS 38801-4934 | 2016-08-19 |
| 1518412691 | Starla Horton | Nurse Practitioner | 830 S Gloster St, 4th Floor East Tower, Tupelo, MS 38801-4934 | 2016-08-18 |
| 1447622196 | Kayla Hood | Nurse Practitioner | 860 S Madison St, Tupelo, MS 38801-4905 | 2015-10-21 |
| 1942686324 | North Mississippi Medical Center, Inc | Nurse Practitioner | 961 S Gloster St, Tupelo, MS 38801-6343 | 2015-08-07 |
| 1205249471 | Lori Hall Forrester | Nurse Practitioner | 4381 S Eason Blvd, Suite 302, Tupelo, MS 38801-6583 | 2014-06-05 |
| 1134427719 | Harminder K Atwal | Nurse Practitioner | 1542 Medical Park Cir, Tupelo, MS 38801-6560 | 2011-03-07 |
| Find all providers in TUPELO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.