MEDICARE: HEATHER M. WILSON FNP

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	13340	TN

General Provider Information

NPI Number	:	1588836472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER M. WILSON FNP

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD UNIT 101
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1383
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-381-1509

Provider Business Practice Location Address
First Line	:	1404 TUSCULUM BLVD STE 3000
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4648
Country	:	US
Telephone Number	:	423-638-1188
Fax Number	:	833-908-2068

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	06/09/2026

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