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NPI Code Detail

MEDICARE: AMY MARIE WILSON

MEDICARE: AMY MARIE 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
1163WL0100XLactation Consultant (Registered Nurse)L-311588OK

General Provider Information

NPI Number : 1790618551
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARIE WILSON
Provider Business Mailing Address
First Line : 7921 NW 38TH ST
Second Line :
City : BETHANY
State : OK
Zip : 73008-3141
Country : US
Telephone Number : 405-301-7005
Fax Number :
Provider Business Practice Location Address
First Line : 11200 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5045
Country : US
Telephone Number : 405-936-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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