MEDICARE: ELIZABETH A WILSON APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	212782	AR

General Provider Information

NPI Number	:	1437004538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A WILSON APRN-CNP

Provider Business Mailing Address
First Line	:	2203 S PROMENADE BLVD STE 5185
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8722
Country	:	US
Telephone Number	:	479-480-7200
Fax Number	:	479-480-7272

Provider Business Practice Location Address
First Line	:	2203 S PROMENADE BLVD STE 5185
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8722
Country	:	US
Telephone Number	:	479-480-7200
Fax Number	:	479-480-7272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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