Provider Demographics
NPI:1861151847
Name:WILSON, HANNAH POFF (FNP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:POFF
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CARTER FLTS
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-7111
Mailing Address - Country:US
Mailing Address - Phone:662-316-3459
Mailing Address - Fax:
Practice Address - Street 1:15921 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7740
Practice Address - Country:US
Practice Address - Phone:662-224-8951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner