MR. NELSON WILSON IV (NPI# 1528228863) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528228863 |
| Entity Type | Individual |
| Full Name | MR. NELSON WILSON IV |
| Credential | CP |
| Practice Address |
801 E Northside Dr Suite D Clinton MS 39056-3663 |
| Practice Telephone | 6019242888 |
| Practice Fax Number | 6019242885 |
| Mailing Telephone | 6019242888 |
| Mailing Fax Number | 6019242885 |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1744P3200X |
Specialist Specialization: Prosthetics Case Management |
C36423 | MS | Other Service Providers |
| Street Address |
801 E NORTHSIDE DR SUITE D |
| City | CLINTON |
| State | MS |
| Zip Code | 39056-3663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740448802 | Johnnie Mae Owens | Orthotic Fitter | 801 E Northside Dr, Suite D, Clinton, MS 39056-3663 | 2008-05-27 |
| 1912141516 | Nelson Wilson, Iv | Prosthetic/Orthotic Supplier | 801 E Northside Dr, Suite D, Clinton, MS 39056-3663 | 2009-04-27 |
| 1710147301 | Custom Prosthetic & Orthotic | Prosthetic/Orthotic Supplier | 801 E Northside Dr, Suite - D, Clinton, MS 39056-3663 | 2008-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376012724 | John Melvin Goolsby Jr. | Dentist | 457 Highway 80 East, Clinton, MS 39056 | 2018-11-15 |
| 1225534530 | Magnolia Allergy Clinic LLC | Internal Medicine | 402 Cynthia St Ste E, Clinton, MS 39056 | 2018-04-04 |
| 1578093704 | Melinda A Weisenberger | Specialist/Technologist | 4600 W Northside Drive, Clinton, MS 39056 | 2017-06-20 |
| 1962859702 | Telehealthone, LLC | Nurse Practitioner | 200 Clinton Plaza, Clinton, MS 39056 | 2016-05-23 |
| 1841686581 | 1st America Infusion Services LLC | Durable Medical Equipment & Medical Supplies | 132 Fairmont Street, Suite B, Clinton, MS 39056 | 2015-04-09 |
| 1023412822 | Rebecca Brooks Prewitt | Social Worker | 130 B Fairmont Street, Clinton, MS 39056 | 2014-10-22 |
| 1396184149 | Robert Joseph Hargis | Urology | 116 Afton Way, Clinton, MS 39056 | 2013-06-14 |
| 1750626321 | Clinton Dental Care, Inc. | Dentist | 736 Clinton Pkwy, Clinton, MS 39056 | 2012-12-07 |
| 1922394469 | Daphenia C. Knight Starling | Nurse Practitioner | Clinton Healthcare, 1251 Pinehaven Rd, Clinton, MS 39056 | 2011-06-23 |
| 1134443385 | Gwendolyn Coleman Garror | Pharmacist | 132 Fairmount Drive, Clinton, MS 39056 | 2010-03-17 |
| Find all providers in zip 39056 | ||||
| Taxonomy Code | 1744P3200X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| Specialization | Prosthetics Case Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427695717 | Lori A Donoho | Specialist | 6378 Coventry Way, Clinton, MD 20735-2256 | 2019-12-05 |
| 1891261418 | Lucretia Aleather Johnson | Specialist | 6451 Alexander Ferry Rd, Clinton, MD 20735-3414 | 2018-10-22 |
| 1407359961 | Tamika La Cher Phelps | Specialist | 4615 Mary Beth Blvd, Clinton, MD 20735-9625 | 2018-03-12 |
| 1851501696 | Dawn B. Benner | Specialist | 218 Lisbon St, Clinton, NC 28328-4115 | 2007-05-23 |
| 1821208661 | David B. Benner | Specialist | 218 Lisbon St, Clinton, NC 28328-4115 | 2007-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932715216 | Stacy Michelle Reed | Specialist | 121 Lonnie Jenkins Dr, Pearl, MS 39208-3520 | 2020-09-22 |
| 1962014100 | Orthotic & Prosthetic Solutions LLC | Specialist | 3670 Lakeland Ln # B-4, Jackson, MS 39216-4700 | 2020-08-19 |
| 1023653714 | Aundray Terall Shackelford | Specialist | 105 Rankin Blvd Ext, Tupelo, MS 38801-4611 | 2019-11-17 |
| 1194383398 | Candice Williams | Specialist | 820 N Gloster St, Tupelo, MS 38804-1949 | 2019-06-03 |
| 1598252645 | Catiecha L Edwards | Specialist | 1162 Franklin St, Grenada, MS 38901-4237 | 2018-04-14 |
| 1992200950 | Cristy M Mathews | Specialist | 132 Paulding Rd, Leakesville, MS 39451-3073 | 2018-03-29 |
| 1386146520 | Jan A Jordan | Specialist | 1615 2nd Ave N, Columbus, MS 39701-4927 | 2018-03-04 |
| 1679085948 | Alan Evans | Specialist | 106 North Lafayette St, Starkville, MS 39759 | 2017-10-26 |
| 1649725409 | Tynita Steele | Specialist | 5304 Gautier Vancleave Rd, Gautier, MS 39553-4216 | 2016-08-22 |
| 1285097048 | The Lauren Forte Hair Loss Replacement Center | Specialist | 143 Laura Lake Rd, Vicksburg, MS 39180-9787 | 2016-03-30 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MR. NELSON WILSON IV.
| 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.