THE WREN CLINIC, PC (NPI# 1063639185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063639185 |
| Entity Type | Organization |
| Organization Name | THE WREN CLINIC, PC |
| Other Organization Name | NORTHEAST MISSISSIPPI DERMATOLOGY CENTER, PC |
| Practice Address |
874 Barnes Crossing Rd Tupelo MS 38804-0909 |
| Mailing Address |
Po Box 1530 Dept 185 Southaven MS 38671-1530 |
| Practice Telephone | 6628912999 |
| Practice Fax Number | 6622860106 |
| Mailing Telephone | 6628912999 |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-01-17 |
| Authorized Official Name | DR. CHARLES M. WREN II (PRESIDENT) |
| Authorized Official Telephone | 6628912999 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 14798 | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Northeast Mississippi Dermatology Center, PC | Former Legal Business Name - Organization |
| Street Address |
874 BARNES CROSSING RD |
| City | TUPELO |
| State | MS |
| Zip Code | 38804-0909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295816072 | William M. Hilbun Jr. | Family Medicine | 874 Barnes Crossing Rd, Suite A, Tupelo, MS 38804-0909 | 2006-10-18 |
| 1831705565 | Emalee Gullick | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2020-09-17 |
| 1265047484 | Jakob Slusher | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2020-09-14 |
| 1508335878 | Stephanie Brooke Reeves | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2018-11-16 |
| 1457850729 | Lindsay Claire Weatherford | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2018-02-01 |
| 1205356870 | Bethany Alise Cummings | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2017-06-23 |
| 1174075220 | Kevin Floyd | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2016-10-25 |
| 1750740965 | Dana Grant | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2016-02-16 |
| 1144603325 | Ginger Carol Lowman | Nurse Practitioner | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2015-07-07 |
| 1881077501 | Medplus Urgent Clinic LLC | Clinic/Center | 874 Barnes Crossing Rd, Tupelo, MS 38804-0909 | 2015-06-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1134762784 | Kimberly J Adams | Occupational Therapy Assistant | 90 Clark Ave, Tupelo, MS 38804 | 2019-10-25 |
| 1790270924 | Megan Guntharp | Occupational Therapist | 960 Commonwealth Boulevard, Tupelo, MS 38804 | 2018-06-29 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1790235919 | Dr Scott Dickinson D.m. D. PC | Dentist | 3999 N Gloster Street, Tupelo, MS 38804 | 2016-10-12 |
| 1326496621 | Angela Estes | Occupational Therapist | County Road 1279 House#197, Tupelo, MS 38804 | 2016-05-26 |
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1104238898 | Stella M. Johnson | Social Worker | 2292 Camelot Cir, Tupelo, MS 38804 | 2014-05-29 |
| 1821437351 | Lenka Petersen | Student in an Organized Health Care Education/Training Program | 1665 S Green St., Nmmc, Tupelo, MS 38804 | 2013-06-18 |
| 1083966303 | Jessica M Baskett | Counselor | 398 E Main St, Tupelo, MS 38804 | 2012-10-10 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972537355 | Jeffrey C Houin | Dermatology | 516 Pegram Dr, Tupelo, MS 38801-6347 | 2006-07-10 |
| 1215249131 | Bradley Noel Greenhaw | Dermatology | 516 Pegram Dr, Tupelo, MS 38801-6347 | 2010-07-08 |
| 1053491605 | Dermatology Center of North Ms Pa | Dermatology | 516 Pegram Dr, Tupelo, MS 38801-6347 | 2006-10-17 |
| 1518991033 | John D Burk | Dermatology | 516 Pegram Dr, Tupelo, MS 38801-6347 | 2006-07-10 |
| 1629016126 | Charles M Wren II | Dermatology | 830 S Gloster St, Tupelo, MS 38801-4934 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760043046 | Skin In The Game, Pllc | Dermatology | 6510 Highway 90, Gautier, MS 39553-5015 | 2019-06-26 |
| 1427535079 | Jenna Joe Rose Cooper | Dermatology | 2204 Jefferson Davis Dr, Oxford, MS 38655-5222 | 2018-07-26 |
| 1427460849 | Anna Allred Wile | Dermatology | 4331 Highway 39 N Ste A, Meridian, MS 39301-1007 | 2014-05-21 |
| 1134558331 | South Central Clinics, Inc | Dermatology | 920 Matthew Dr Ste 8, Waynesboro, MS 39367-2553 | 2013-11-07 |
| 1407296825 | Ashley Nicole Emerson | Dermatology | 6510 Highway 90 Ste C, Gautier, MS 39553-5015 | 2013-06-29 |
| 1265729719 | Jasmine C. Hollinger | Dermatology | 2080 S Frontage Rd Ste 113, Vicksburg, MS 39180-5882 | 2011-07-06 |
| 1295022861 | Kenneth Daniel Saul | Dermatology | 5002 Highway 39 N Bldg A, Meridian, MS 39301-1078 | 2011-07-05 |
| 1689969735 | Adam C Byrd | Dermatology | 313 N Court Ave, Ummc Dermatology - Louisville Clinic, Louisville, MS 39339 | 2011-06-16 |
| 1063724987 | Lyndsay R Shipp | Dermatology | 705 Sisk Ave Ste 105, Oxford, MS 38655-3413 | 2010-07-08 |
| 1144545195 | Lisa Renee Chastant | Dermatology | 81 Mdos/sgomd, 301 Fisher St., Keesler Afb, MS 39534-2519 | 2010-04-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.