1659462950 NPI number — MRS. GINGER CORRERO WILKINSON MED, CMHT

Table of content: MRS. GINGER CORRERO WILKINSON MED, CMHT (NPI 1659462950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659462950 NPI number — MRS. GINGER CORRERO WILKINSON MED, CMHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINSON
Provider First Name:
GINGER
Provider Middle Name:
CORRERO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED, CMHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTSON
Provider Other First Name:
GINGER
Provider Other Middle Name:
CORRERO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED, CMHT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659462950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2434 SOUTH EASON BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38804-6942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-844-0047
Provider Business Mailing Address Fax Number:
662-680-6416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2434 SOUTH EASON BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38804-6942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-844-0047
Provider Business Practice Location Address Fax Number:
662-680-6416
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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