Healthcare Provider Details

I. General information

NPI: 1669026944
Provider Name (Legal Business Name): AMBER NICOLE WILCOX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 S 7TH ST STE A
TERRE HAUTE IN
47802-3558
US

IV. Provider business mailing address

2723 S 7TH ST STE A
TERRE HAUTE IN
47802-3558
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-8164
  • Fax: 812-234-6391
Mailing address:
  • Phone: 812-238-1730
  • Fax: 812-242-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10002776A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: