BRANDYE NICOLE WILSON (NPI# 1215189618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215189618 |
| Entity Type | Individual |
| Full Name | BRANDYE NICOLE WILSON |
| Credential | P.A. |
| Practice Address |
125 Goodman Rd W Ste D Southaven MS 38671-9481 |
| Mailing Address |
206 Oxford Rd New Albany MS 38652-3115 |
| Practice Telephone | 6629323560 |
| Practice Fax Number | 6625342330 |
| Mailing Telephone | 6625342227 |
| Mailing Fax Number | 6625342330 |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2020-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA00448 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA362 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | MS MEDICARE | 873993 | 01 |
| MS | 00133522 | 05 |
| Street Address |
125 GOODMAN RD W STE D |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-9481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497396931 | Ortho Express Holding Company, LLC | Orthopaedic Surgery | 125 Goodman Rd W Ste D, Southaven, MS 38671-9481 | 2019-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467097956 | Chandler Stengel | Physician Assistant | 7900 Airways Blvd., Ste B102, Southaven, MS 38671-5809 | 2019-11-08 |
| 1104431485 | Jacob Cole Lee | Physician Assistant | 7545 Airways Blvd, Southaven, MS 38671-5806 | 2020-09-13 |
| 1598395501 | Raymond Bennett Caldwell Iv | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2020-01-17 |
| 1659844595 | Barry T Flippo | Physician Assistant | 7585 Clarington Cv, Southaven, MS 38671-5656 | 2019-01-03 |
| 1750871299 | Alejandro Polania | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2018-05-10 |
| 1134675465 | Nikara Kilpatrick | Physician Assistant | 9140 Highway 51 N, Southaven, MS 38671-1233 | 2016-08-28 |
| 1386097921 | Wesley Boyd | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2016-07-19 |
| 1255748604 | Donald Wayne Washburn IIi | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2014-07-17 |
| 1750797700 | Richard Evan Swift | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2014-07-09 |
| 1437499084 | Michael Louis Lipscomb | Physician Assistant | 7601 Southcrest Pkwy, Southaven, MS 38671-4739 | 2013-02-19 |
| Find all providers in SOUTHAVEN | ||||
Please comment or provide details below to improve the information on BRANDYE NICOLE WILSON.
| 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.