Kenyatta Nicole Wilson, NP-C - Medicare Nurse Practitioner in Vicksburg, MS

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Kenyatta Nicole Wilson, NP-C is a medicare enrolled "Nurse Practitioner - Family" in Vicksburg, Mississippi. She graduated from nursing school in 2011 and has 14 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Medical Foundation Of Central Mississippi Inc, Vicksburg Clinic Llc and her current practice location is 2200 Highway 61 N, Vicksburg, Mississippi. You can reach out to her office (for appointments etc.) via phone at (601) 883-3340.

Kenyatta Nicole Wilson is licensed to practice in Mississippi (license number R871546) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1457633034.

Contact Information

Kenyatta Nicole Wilson, NP-C
2200 Highway 61 N,
Vicksburg, MS 39183-8246
(601) 883-3340
Not Available

Map and Direction




Provider's Profile

Full NameKenyatta Nicole Wilson
GenderFemale
SpecialityNurse Practitioner
Experience14 Years
Location2200 Highway 61 N, Vicksburg, Mississippi
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Kenyatta Nicole Wilson graduated from nursing school in 2011
  NPI Data:
  • NPI Number: 1457633034
  • Provider Enumeration Date: 09/09/2011
  • Last Update Date: 05/29/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 5799943106
  • Enrollment ID: I20120214000728

Medical Identifiers

Medical identifiers for Kenyatta Nicole Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1457633034NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family R871546 (Mississippi)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Merit Health River RegionVicksburg, MSHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Medical Foundation Of Central Mississippi Inc1153216411236
Vicksburg Clinic Llc589069633023

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kenyatta Nicole Wilson allows following entities to bill medicare on her behalf.
Entity NameVicksburg Clinic Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1790711158
PECOS PAC ID: 5890696330
Enrollment ID: O20040116000738
Entity NameMedical Foundation Of Central Mississippi Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992774814
PECOS PAC ID: 1153216411
Enrollment ID: O20040217000380
Entity NameFitness Clinic Wellness
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1912352022
PECOS PAC ID: 4486938719
Enrollment ID: O20170303001462

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kenyatta Nicole Wilson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Kenyatta Nicole Wilson, NP-C
2200 Highway 61 N,
Vicksburg, MS 39183-8246

Ph: (601) 529-1445		Kenyatta Nicole Wilson, NP-C
2200 Highway 61 N,
Vicksburg, MS 39183-8246

Ph: (601) 883-3340

Reviews and Comments


Nurse Practitioner Nurses in Vicksburg, MS

Mrs. Brittany Sharda Barnes, NURSE PRACTITIONER
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 919 Mission 66, Vicksburg, MS 39183
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Mrs. Kimberly Fuller, MSN, ACNP - BS
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Practice Location: 2100 Highway 61 N, Vicksburg, MS 39183
Phone: 601-883-5000    
Mrs. Latasha Jackson Claiborne, PMHNP
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Medicare: Medicare Enrolled
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Nina Tomlinson,
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Practice Location: 807 Monroe St, Vicksburg, MS 39183
Phone: 601-636-4356    
Linda Cheslek,
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Medicare: Not Enrolled in Medicare
Practice Location: 807 Monroe St, Vicksburg, MS 39183
Phone: 601-636-4356    
Kerrie Sanders- Smith,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 4077 Pemberton Square Blvd, Vicksburg, MS 39180
Phone: 601-638-8600    
Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 2011 Highway 61 N, Vicksburg, MS 39183
Phone: 014-562-2776    Fax: 601-456-2622

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.