Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health, PLLC

Organization Nurse Practitioner · NPI 1134795628

Providence Health, PLLC is a Nurse Practitioner in Southaven, Mississippi. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

7075 Golden Oaks Loop W Ste 10
Southaven, MS 38671-9012
Phone: (901) 486-0439
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X

Record details

NPI number1134795628
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Irene Wilson — Fnp-C · (901) 486-0439
Other names Providence Health
NPI enumeratedJune 3, 2021
Last updated in NPPESJune 3, 2021
Certification dateJune 3, 2021
Mailing address481 Clarington Dr, Southaven, MS 38671-5638

Other providers in Southaven