MEDICARE: MS. NANCY PRATT WILSON NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	RN0000134308	TN

General Provider Information

NPI Number	:	1699731638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY PRATT WILSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2585 HORSHAM DR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6665
Country	:	US
Telephone Number	:	901-759-5908
Fax Number	:	901-759-5908

Provider Business Practice Location Address
First Line	:	314TH MEDICAL OPERATIONS SQUADRON 1090 ARNOLD DRIV
Second Line	:
City	:	LITTLE ROCK AFB
State	:	AR
Zip	:	72099-0001
Country	:	US
Telephone Number	:	501-987-7234
Fax Number	:	501-987-7216

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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