Healthcare Provider Details

I. General information

NPI: 1265351092
Provider Name (Legal Business Name): NANCY MARIE WILSON DNP, RN, PED-BC, RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITHVILLE CHURCH RD
WARNER ROBINS GA
31088-9092
US

IV. Provider business mailing address

308 SOUTHLAND TRL
BYRON GA
31008-6065
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-5923
  • Fax:
Mailing address:
  • Phone: 478-923-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN141983
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: