Healthcare Provider Details

I. General information

NPI: 1902431885
Provider Name (Legal Business Name): NICHOLE PARKER WILSON MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 VENTURE DR
SMITHFIELD NC
27577-4721
US

IV. Provider business mailing address

560G PARKERTOWN RD
FOUR OAKS NC
27524-8907
US

V. Phone/Fax

Practice location:
  • Phone: 919-355-8111
  • Fax:
Mailing address:
  • Phone: 919-398-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01200458
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013027
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: