Healthcare Provider Details

I. General information

NPI: 1780501049
Provider Name (Legal Business Name): JESS WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESS LUTTRELL

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 COOL STONE BEND DR
AUBURN AL
36832-7500
US

IV. Provider business mailing address

348 SAMFORD VILLAGE CT # 130
AUBURN AL
36830-6383
US

V. Phone/Fax

Practice location:
  • Phone: 256-393-8424
  • Fax:
Mailing address:
  • Phone: 256-393-8424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6958G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: