KENYATTA NICOLE WILSON NP-C
NPI 1457633034
Nurse Practitioner - Family in Vicksburg, MS
About Kenyatta Nicole Wilson Np-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KENYATTA NICOLE WILSON NP-C (NPI 1457633034) is an individual family provider in Vicksburg, Mississippi, licensed in Mississippi (R871546) and active in the NPI registry since September 2011. She is enrolled in Medicare PECOS, is affiliated with Merit Health River Region, and maintains a secondary practice location in Clinton.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Location 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kenyatta Nicole Wilson Np-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Kenyatta Wilson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Vicksburg, MS 39183
- Reassigned Medicare billing, Mississippi enrollment
- 41 clinicians in this Medicare group
Jackson, MS 39204
- Reassigned Medicare billing, Mississippi enrollment
- 26 clinicians in this Medicare group
Crystal Springs, MS 39059
- Reassigned Medicare billing, Mississippi enrollment
- Medicare enrollment name: Medical Foundation Of Central Mississippi Inc
- 423 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 5
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Merit Health River Region
Acute Care Hospitals · Vicksburg, MSPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 39183 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
VICKSBURG, MS 39183
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kenyatta Wilson's NPI number?
The NPI number for Kenyatta Wilson is 1457633034. It was assigned to this individual provider in the NPPES registry on September 9, 2011. The provider is also known as Kenyatta N Moore Np-C.
Where is Kenyatta Wilson located?
Kenyatta Wilson practices at 2200 Highway 61 N, Vicksburg, MS 39183. The listed phone number is (601) 883-3340.
What is Kenyatta Wilson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Kenyatta Wilson enrolled in Medicare?
Yes. Kenyatta Wilson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kenyatta Wilson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenyatta Wilson reassigns Medicare benefits to 3 organizations: Vicksburg Clinic LLC (Vicksburg, MS), Fitness Clinic Wellness (Jackson, MS) and Baptist Jackson Heart Cardiology Clinic-Crystal Springs (Crystal Springs, MS). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kenyatta Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kenyatta Wilson accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 4 other insurers list Kenyatta Wilson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Kenyatta Wilson affiliated with any hospitals?
According to CMS data, Kenyatta Wilson is affiliated with Merit Health River Region.
When was this NPI record last updated?
The NPPES record for Kenyatta Wilson was last updated on May 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kenyatta Nicole Wilson, NP-C · NPI 1457633034
Family physician in Vicksburg, Mississippi. Individual provider, active in the CMS NPPES registry since September 9, 2011.
## Identity
- **NPI:** 1457633034 (Entity type: Individual)
- **Enumerated:** September 9, 2011
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** R871546 (Mississippi)
- **Sole proprietor:** No
## Practice location
- **Address:** 2200 HIGHWAY 61 N, Vicksburg, MS 39183-8246
- **Phone:** (601) 883-3340
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Vicksburg Clinic LLC (NPI 1790711158, Vicksburg, MS); Fitness Clinic Wellness (NPI 1912352022, Jackson, MS); Baptist Jackson Heart Cardiology Clinic-Crystal Springs (NPI 1447510581, Crystal Springs, MS) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2011
## Record status
- **NPPES last updated:** May 29, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1457633034) · Data from the CMS NPPES public registry.