MEDICARE: JESSICA WILSON

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	APRN-NP712085	GA
2	163W00000X	Registered Nurse	RN712085	GA

General Provider Information

NPI Number	:	1760335848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WILSON

Provider Business Mailing Address
First Line	:	603 ASHFORD ESTATES AVE
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-3023
Country	:	US
Telephone Number	:	352-484-5844
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 ASHFORD ESTATES AVE
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-3023
Country	:	US
Telephone Number	:	352-484-5844
Fax Number	:

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	03/04/2026

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Directions to “ JESSICA WILSON ” Practice Location

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