BRADLEY CRAIG WILSON (NPI# 1235519984) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235519984 |
| Entity Type | Individual |
| Full Name | BRADLEY CRAIG WILSON |
| Practice Address |
2807 Montclair Ave Pascagoula MS 39567-5287 |
| Practice Telephone | 9103825414 |
| Mailing Telephone | 9103825414 |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-06-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699061598 | Bradley Paul Wilson | Student in an Organized Health Care Education/Training Program | 349 17th Ave, San Francisco, CA 94121-2312 | 2011-06-20 |
| 1407084791 | Bradley Allen Wilson | Urology | 500 E Robinson Suite 1300, Norman Urology Associates, PC, Norman, OK 73071-6694 | 2009-06-25 |
| 1053329185 | Bradley Rix Wilson | Dentist | 2077 S Gessner Rd, Suite 125, Houston, TX 77063-1147 | 2006-08-04 |
| 1528046141 | Bradley A Wilson | Surgery | 1000 Health Center Dr Ste 101, Mattoon, IL 61938-4644 | 2006-01-04 |
| 1225020878 | Bradley C Wilson | Family Medicine | 7756 State Route 37 E, New Lexington, OH 43764-9512 | 2005-08-19 |
| 1366078990 | Bradley Clark Wilson | Case Manager/Care Coordinator | 2005 Ashland Ave, Toledo, OH 43620-1703 | 2020-03-16 |
| 1508339987 | Bradley Russell Wilson | Nurse Practitioner | 22101 Moross Rd, Detroit, MI 48236-2148 | 2019-01-08 |
| 1386985133 | Bradley W Wilson | Nurse Anesthetist, Certified Registered | 300 North Ave, Battle Creek, MI 49017-3307 | 2013-03-04 |
| 1609130954 | Bradley Lyle Wilson | Family Medicine | 4771 S Cleveland Ave, Fort Myers, FL 33907 | 2012-07-02 |
| 1174810824 | Bradley Jay Wilson | Radiology | 11800 E 12 Mile Rd, Warren, MI 48093-3472 | 2011-07-01 |
| Street Address |
2807 MONTCLAIR AVE |
| City | PASCAGOULA |
| State | MS |
| Zip Code | 39567-5287 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316439615 | Quad/med, LLC | Clinic/Center | 1000 Jere St. Pe' Hwy, C/o Ingalls Main Substation, 1st Floor, Pascagoula, MS 39567 | 2018-06-01 |
| 1477948107 | Market Place Pharmacy, LLC | Pharmacy | 1965 Market Street, Pascagoula, MS 39567 | 2015-03-31 |
| 1518382266 | Randy S Kirksey | Social Worker | 1017 Farnworth Ave, Pascagoula, MS 39567 | 2014-03-04 |
| 1063710747 | Hinman Chiropractic Care, Pa | Chiropractor | 3215 Market Street, Pascagoula, MS 39567 | 2011-03-04 |
| 1215232830 | Jessica E Shores | Military Health Care Provider | 1000 Access Rd Bldg 2026, Pascagoula, MS 39567 | 2011-01-12 |
| 1912214438 | Walker Chiropractic Center, Pllc | Chiropractor | 1408 Ingalls Ave, Pascagoula, MS 39567 | 2010-09-03 |
| 1386979961 | South Mississippi Ear, Nose and Throat | Otolaryngology | 2525 Telephone Road, Pascagoula, MS 39567 | 2009-10-15 |
| 1720299415 | James H Halbrook | Dentist | 2202 Old Mobile Hwy, Pascagoula, MS 39567 | 2007-05-24 |
| 1871624627 | Thayne Christopher Griener | Otolaryngology | 2812 Andrews Avenue, Pascagoula, MS 39567 | 2007-03-07 |
| 1447318159 | Ada Ruth Bosarge | Physical Therapist | 2838 Andrew St, Pascagoula, MS 39567 | 2006-12-05 |
| Find all providers in zip 39567 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215232830 | Jessica E Shores | Military Health Care Provider | 1000 Access Rd Bldg 2026, Pascagoula, MS 39567 | 2011-01-12 |
| 1477520666 | Thomas William Holder | Military Health Care Provider | Medical Department, 2000 Jerry St Pe Hwy, Pascagoula, MS 39568-7003 | 2006-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043747553 | Rowdy Pameticky | Military Health Care Provider | 952 Poni Pl, Diamondhead, MS 39525-4135 | 2017-05-15 |
| 1528515046 | Nicolas Riley | Military Health Care Provider | 5501 Marvin Shields Blvd., Gulfport, MS 39501-5007 | 2016-09-01 |
| 1477932200 | Michael Alexander Boartfield | Military Health Care Provider | 4033a Mallard Cv, Gulfport, MS 39501-2833 | 2015-05-26 |
| 1336536531 | Jeffrey Alexander Leemauk | Military Health Care Provider | 4010a Blue Heron Way, Gulfport, MS 39501-2815 | 2015-04-25 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| 1427316041 | Jeremiah John Baldwin | Military Health Care Provider | 5303 Marvin Shields Blvd, Gulfport, MS 39501-9013 | 2012-05-02 |
| 1124341763 | Trevor James Trout | Military Health Care Provider | 2603 Lower Gainesville Rd, Stennis Space Center, MS 39529-0001 | 2010-03-10 |
| 1245563162 | Jenesia Arielle Dillow Ordonia | Military Health Care Provider | 3158b Holloway Dr, Gulfport, MS 39501-9030 | 2009-09-10 |
| 1326298795 | Greg Allan Lassiter | Military Health Care Provider | 3110 B Seagull St, Gulfport, MS 39501 | 2008-09-23 |
| 1124203187 | James Sheldon Burnett | Military Health Care Provider | Nmcb 74, Unit 60243, Gulfport, MS 34099 | 2008-01-08 |
| Find all providers with the same taxonomy | ||||
| City | PASCAGOULA |
| Zip Code | 39567 |
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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.